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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 1 g Additions
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APPLICATION FOR PERMIT TO ALTER Repair
r i(� _ ' Garage
1. Location �
`-' '� Lot No.
2. Owner's name � t� 7"\; ! - Address
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
6. New Porch
7. Is existing building to be demolished?
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost-
The undersigned certifies that the above statements are we to the best of his, her
L knowledge and belief.
Signature of responsible aticant
Remarks
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lifa of 'Nar#lTaIllptoll
� 6,C� � ,�Llasascltosetta
to ' A "MENT OF BUILDING INSPECTIONS
INSPECTOR
�hD10 12 Main Street ' Municipal Building
'' ���
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE:
JOB LOCATION•
(Mag� (Parcel) (Subdivision)
HOMEOWNER:
(Name & ,Addres ) �..
(Home Phone) (Work Phone )
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one ( 1 )or two (2) families and to allow such
homeowner to engage an individual for hire who does not possess a `
license, provided that the owner acts as supervisor. CMR780 Section 109. 1 . 1
DEFINITION OF HOMEOWNER: Person( s ) who own a parcel of land on
which he/she resides or intends to reside, on which there is, or is
intended to be, a one or two family dwelling, attached or detached
structures accessory to such use and/or farm structures . A person who
constructs more than one home in a two-year period shall not be
considered a homeowner. Such "homeowner" shall submit to the Building
Official, on a form acceptable to the Building Official, that he/she
shall be responsible for all such work performed under the building
permit.
As acting Construction Supervisor your presence on the job site
will be required from time to time, during and upon completion of the
work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers '
Compensation) and Chapter 153 (Liability of Employers to Employees for
injuries not resulting in Death) of the Massachusetts General Laws
Annotated, you may be liable for person( s ) you hire to perform work for
you under this permit.
The undersigned "homeowner" certifies and assumes responsibility
for compliance with the State Building Code, City of Northampton
Ordinances, State and Local Zoning Laws , and State of Massachusetts
General Laws Annotated.
HOMEOWNER SIGNATURE
BUILDING PERMIT #
4� P �.
6,tJ J �Z XX Wort 4aillp foil
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9 H � � �restachnsctta
(1 60
'DEPARTMENT OF BUILDITIG INSPECTIONS
t?yFl �3Y"lad ' •
• ��q�{�S 212 Main Street Municipal Building
Northampton, Mass.• 01060
WORTCER'S CO`iYTENSA.'TION' MSU1Z NCE AFFMAVIT
(li cevscc/ rmi tics)
+nth a principal place of business/residence at:
. (phoney/)
(str-w6 ty/sta ffhi p)
do hereby certify, under the pains and penalties of pe-gury, that
( ) I am an employer providing the following worker's compensation coverage for my '
employees worming on this job:
(Lnsi=ce Company) (Policy Number) (Expiration Date)
( ) I atn a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contcmci0r) (Lns"u2r1cC Cornpaoy/Pobc;NusTih-cr) (�\plr3L00 D,
(Naljne of Contractor) COII1DanvlpOhcr Number) (Ezoinfion Da(c)
(Name of Connector) (L sim-ance Company/Poky Number) (Expiraaon Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expira[iou Date)
(much_dditionat t±'. ifn(.oasuy to ac1U(Sc inf;:m ico pa•sung to aU cod-Ldion)
( ) I am a sole proprietor and have no one working for me.
( ) X am a home owner performing all the work myself.
NOTE:please be aware thai tvhilo homcoµvm wao ciaplay persom to do— + •^n�uaioo-or rc=pair work on i d,,-c li g or
not mote th n thmo tniitt La,,, the bomoawvcr resiaw or oa the grouodx appurtl^•^+tb, nm oot Erner xilY oomidcred to be
cmploym under tha worker's oeorpc as. ica Act(GL152,=1(5)),application by a homoow of r for a liccase oc permit may evidence the
legal rtahu of an omptoyor under dw Workoes Coaxpomaiion AeL
I andcraxnd tb t a copy of.this saarcmcos m.y bo fomyr to the DeQortmeM of In6rstri e1 Amd—&Offioo of rnsvrznea for tb.
coverage vcrifirsiioo and that t ultac to st u oovcrngo under socdoa 23A of 1.(GL 132 can lord to tbo imposition of criminal pan-116-
ooawtng of a•fine of up to S 1,5OO: sndloc�prisocmcat of tip to ooc Y=and civil pcmttia in the form of a Stop Work Olds and a 1
fino of 5100.00 a hay against me-
Foe depctineahl tiro on1Y.
Sivnatu»ofLior�Cimi
• :4'-;rt7J F`,.� �'-.' _`2'��'�.T�t.°'�+�x`%:.�1,..-X - :.U�-:r�tlr'���rs;;.'s, -
10. Do any signs exist on the property? YES NO
IF YES, describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES NO
IF YES,describe size,type and location:
11 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This —1— to be filled in
by the Building Da par tmeat
Required
Existing Proposed By Zoning
I Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&p_=l•ed park.zn-N
# of Parking Spaces
# 'of Loading Docks
Fill:
-(volume -& location)
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
DATE: �� lam.)
���'�� E��1Y APPLICANT's SIGNATURE
NOTE: Issuanoe of a zoning permit does not relieve an applioa-dr burden to oom pty witty all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appiloable permit granting authorities.
FILE #
NOV 6 1998
>
File No'
NOR I H,Ah'TTON,MA 01067 v� ��� �� � �
�"^� � ^===�� �=^ � =�==�-�~=~ « ,�'��~ . w��
PLEASE TYPE OR PRINT ALL INFORMATION
/7
1. Name mfApplicant:
-
Address:
2. Owner of Property:
Address:— Telephone:
3. Status ofApplicant: er -Contract Purchaser Lessee
Other(explain):
i
4, Job Location;
Parcel Id: Zoning YNap Parce| Dimtrict(s
(TO 8E FILLED |NBY THE BUILDING DEPARTMENT)
5 Existing Use ofStruoturo/Ppopedy
6. Description fProposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
`
7 Attached Plans: Sketch Plan Site Plan nginaonad/Sun/eyodP|anu
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8 Has u Special Pernnit/Vahanue/Finding ever been issued for/on the site?
� '._�
N DON'T KNOW YES IF YES,date issued:
IF YES: Was the permit recorded ot the Registry ofDeeds?
NO DON'T KNOW YE
IF YES: enter Book Page_ and/or Document
Q. Does the site contain a brook, body of water orwetlands? NO V-` DON'T KNOW YE
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs tobe obtained Obtained .date issued:
(FORM CONTINUES ON OTHER SIDE)
Reference No: BP-1999-0485
Department: Mechanical Permits ...................................
Building, Elect'rical
.........................................................................................
Fee Type'. Receipt No:
Non structural interior renovations 11F'C1
, -1999-001324
.......................................................................... .............. ..............I..... .................
Paid By: Paid in Full On:
Jean Bushey Thu Nov 12,1998
.......................................................................................... ......................................
Received By: Check No:
Linda Lapointe 1529
......................................................................................... ......................................
DEPARTMENT'S COPY Amount: $20.00
---------------------------
DEPARTMENT FILE COPY 52 BROOKWOOD DR
CITY OF NORTHAMPTON
BUILDING PERMIT
Owner's pulling their own permits or dealing with unregistered contractors for applicable work do
not have access to Guaranty Fund(MGL 142A)
Issued: Permit No: Inspector: Trackiny,No.: Fee:
06 Nov, 1998 BP-1999-0485 $20.00
GIS Map Block: Lot: Address: Zoninjz: Use Group:. Lot Size:
5111 29 388 001 52 BROOKWOOD DR URA 15725.16
Contractor: License Type: Insurance:
Homeowner as Contractor
Address: License No.: Insurance No.:
LkE State: Zip Code: Phone:
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0802 vinyl siding $100.00
Description of Work:
REMOVE WINDOW & INSTALL SIDING
GeoTMS(D 1997 Des Lauriers&Associates,Inc. Signature: