32C-294 (4) i a o
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
a APPLICATION FOR PERMIT TO ALTER Repair
Garage
ulsr-Location �� I�—�L[�dt? � Lot No.
Owner's name Ai--q i2,e Address
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
e.,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
L4-. 1`stimated cost- qV
Th igned cert
i i s a a the above statements are true to the best of his,
no ed and belief.
Signature of responsible app,icant
Remarks
9
e
MAY , 3 E• ; �lassachusctte _
I�h'1/ Ogg
� 'DEPARTMENT OF BUILDING INSPECf.IONS
of ." 212 Main Street • MuniciPat Building '>o�
INSPECTOR
4 yvy
Northampton, MA 01060
Applicant Information
—k1m e—ft L--
ti —--- ----------------
t i
1 am a homeowner performing all work myself
❑ I am a sole proprietor and have no one working in any capacity
❑ I am an employer providing workers' compensation for my employees working on this job.
Company Name-------_---------__--- --
Address
C i t Y-- --------------- Phone#--------
Insurance Co.^-----------_—policy#------ ---
Company Name
Address
City Phone #
Insurance Co. Policy #
Failure to secure coverage as re red under Section 25 A of tylGL 152 can lead to the imposition of criminal
penalties of a fine up to$1500. an !or one years'imprisonment as well as civil penalties in the form of a STOP
WORK 0RJaa of$ 00. 0 a day against me. I understand that a copy of this statement may be
forwarded ves ga,is of the DIA for coverage verification.
1 do hereb p irs an penalties of perjury that the information pr ide above is true and correct.
L„�STgnature Date
Print Name Phone V
Official Use Only- Do not write in this area to be completed by city or town official
City or Town _PermiVLicense 0 _ ❑ 13-2d;rtc Dept
Ltensix�Bond
Check if immediate response is required
❑sel e=m'Dept.
Contact Person _Phone 3F _
E] Heakh Dept.
(riff of wart 11allTPtall
,l elseadluseUe
MAY 1 3 1999 DEPARTMENT OF BUILDING INSPECTIONS
INSPE T 212 Afain Street ' Municipal Building '
T OF ��> a
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
( Please Print)
DATE• 1 41
JOB LOC TI N:
(Map) ( Parcel) `! ( subdivision)
HOMEOWNER: �(`}�} Arm � ��
'(Na-M-4--&--Address)
(Home Phone) (Work hone)
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: Perscn( 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 ilding Code, City of Northampton
Ordinances, State an cal Zon' Laws , and State of Massachusetts
General Laws Annotate r
s
HOMEOWNER SIGNATURE
BUILDING PEA MIT # s
Y
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 col== to be filled in
by the Building D�par tment
Required
� ryu` Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear ---
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paged parking;
# of Parking Spaces
#
of Loading Docks
Fill:
-{volume--& location)
13 . Certification: I hereby certify that the rmatiq c ntained herein
r� is true and accurate to the best of my kn dge.
DATE: APP ;CANT's SIGNATURE
�itSTE: 1 u*n6,4 of a zoning ermit does not relieve an a 66AAW6 loru dan'to oompty with $li
zoning lrements and obtain all required permits from the Board of Health. Conservt+tion
Commission. Department of Publio works and other applioable permit granting authorities.
FILE #
I �,
MAY I 3 °
File No.31-9!Q
L!
9�-
�'':s'T t�F�15i r "s� ^ECT 'c
PERMIT APPLI GA T1:ON ( 10 . 2}
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: darn 1:16W41
W4
Address: iZ-,T Telephone:
2. Owner of Property: f �
Address: &qmk_� Telephone:
3. Status of Applicant: V Owner _Contract Purchaser —Lessee
Other(explain):
4. Job Location: _
Parcel Id: Zoning Map# 3iP Parcel#a� District(s):_� �-
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5, Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
�;
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
S. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNO'At `� YES _ IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO �_ DON'T KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained ,(late issued:
(FORM CONTINUES ON OTHER SIDE)
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24 VALLEY ST BP-1999-0957
GIs#: a4 COMMONWEALTH OF MASSACHUSETTS
�
; ITY OF NORTHAMPTON
L 01
Permit: Suilaing
qM.m2�dstove BUILDING PERMIT
Pe it# Bp-1999-oJ57
Project# JS-1.929-1629
EEsL Cost:$1500.00
Fee:$20,QQ PERMISSION IS HEREBY GRANTED TO:
Const.'Class: Contractor: License.-
Use Group:
Lgt SiptUg.RZ 6796.36 Owner FISHES ADAM E&ELIMBETH R
zoinaza:1w, Ayjy0cant,_
AT_:, 24 VALLEY ST
Applicant Address: Phone: Insurance:
IrS,S`ZIED 01Y:5/13 11999 4:
TO PERFORM THE FOLLOWING WORK.-INSTALL CHIMNEY & WOODSTOVE
POST THIS CARD SO a IS VISIBLE FROM THE STREET
Inspector of Plumbing bupeetor of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings•
Rough: Rough: House#• Foundation: Q k
Final: Final:
Rough Frame:
Gas Fire Department FireplacelC6imney:
Rough: Oils Insulation:
Final: mole Final:'Lf2'I � jQ~ R "'
THIS PERMIT MAY BE REVOKED BY THE CITY F NO Ol' I,ATION OF
ANY OF ITS RULES AND REGULATIONS.'
i re
Fee Tvyc: Recgiu,, t No: Date Paid: Check No Amount:
Building 5/13/1999 0:00:00 $20.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patllo