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'ARTMENT OF BUILDING INSPECTIONS
2 ,.,11fnin Street ' Municipal Building
INSPECTOR Northampton, Mass. OIOGO
HOMEOWNER LICENSE EXEMPTION
,(,� (Please Print)
DATE: ,1/XQ_C7H 3G /`99
JOB LOCATION•
(Map) ( Parcel) / (Subdivision) r1�e
HOMEOWNER: ", S 0j,')rl� AJ`/Y c-,1_ r �/a�Q.�v� " 7X
(Name & Address)
IL113 STV x'1;!f 9/3 7P7 9y3s`
(Home Phone) (Work Phone)
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one ( 1 )or two (2) fami 1 ieS. 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 Annotat
HOMEOWNER SIGNATURE`
BUILDING PERMIT
�0 MAC 3 0 1999
a g' Crit� laf wart1jttnlpfutt k
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w ""IMPARTMENT
OF BUILDTNG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060 '
WORKER'S COMPENSATION INSURANCE AYFIDAVET
(licevsedpcmm ttee)
with a principal place of business/residence at:
IBC NC,YP��fUO iE �'Oi�Q-uCe 1M 0061- (phoneli) 9/3 _SV IWY-13
(str�t/ci ty/statrizi p)
do hereby certify, under the pains and penalties of perjury, that:
O I am an employer providing the following worker's compensation coverage for my
employees working on this job.
(Insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
vg
(Name of Contractor) (Insurance Company/PoLicy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/PoEcy Number) (Expiration Date)
Crvame of Contractor) (Im-uranc°,Company/-Policy Number) (Hxpum6on Dale)
(Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date)
(at-41 additiocsl shed ifnoocn ry to include infoc-initioa pertainin.g to all ooc�radorz)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware this whilo homcowncn who clay persons to do mxiErL�coat wuoo or repair work on a dwelling of
not mcco than throo tmits is which the bom6waxr resides of oo the grounds appurtenant i1jacto wz oo(ec3j a ry oomidcrcd to be
employm under tbo workers oompassatioo Act(GL152-"1(5)�application by n homeowner for a Gccasc cc pc fm may cvidcnce tho
Icgal ctahra of an omployor under tho Wockoe&Compomalio a Act
I undalund that a oopy of thu rutcmmt.may bo f«worded to the Dtpartmm2 of indushid Attide+rt>'Offioo of lmucanoo for the
oovaxge vcn5calioo and that failure to sea=covcrngv undo soc Lion 23A of MGL 152 cin kid to tbd impact of aiminal pea Wcs
oomisting of x 1me of up to S 1,500.00 InNor imp of tip to one year and civil penalties in the foctn of a Stop Work Ordcr and a
fine of 5100.00 a day against the
For dcpartnscotil—only
permit Number
3a-C,S -Lot#
Si of Li ermiticc
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.413 .S)N 'F4 3 Alterations
NORTHAMPTON, MASS. rnak Q N 30 19:3 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location i 3 G -rib ,o.,,e.r VYl jq O 10 2 Lot No.
2. Owner's name k e,p r 5 O ' iA ri'e►., J r' Address 13G
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition AA -,/ 5 Ae cP Jc:� X l
5. Alteration ,
6. New Porch
7. Is existing building to be demolished? No
8. Repair after the fire A/o
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
knowledge and bei7k f gnature ofresponsib(e appicant
Remarks � FAT3
10 Do any signs exist on the property? YES NO V
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 cola= to be filled in
by the Building Depeztmeat
I Required I
Existing Proposed By Zoning
Lot size
-- I489S S'. �. 1 �5 S.r.
Frontage 6t 6 0
Setbacks � -F
- side L: 3s R: 3 C) L: * R:_
- rear
Building height Q ,
Bldg Square footage
%Open Space:
(Lot area minus bldg
&p?,ved FarkLnggi
# of -Parking Spaces
# of Loading Docks 0
Fill:
4 volume -& location) U
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
1
DATE: '3-3-- -9 j APPLICANT's SIGNATURE
NOTE: Issuanoe of at zoning permit does not relieve an ap ioant's rden to com
zoning requirements and obtain call required Pty with all
q Permits from the Boa of Health, Conservtation
Commission, Department of Publio Works and other applicable pe it
granting authoritje,s.
FILE ,
V
MAR 3 0 RQO g
File No.
w.. ING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRSNT ALL INFORMATION
1. Name of Applicant: !2 ur -5 t^If�J r
Address: 1-�C 1a c re 6 r ou l< Or- Telephone: !413
2. Owner of Property: 7 Arn -P
Address: Telephone:
3. Status of Applicant: ✓ Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: _ 4ey- e_ (f
Parcel Id: Zoning Map# 0�l? Parcel# i _ District(s):
(TO BE FILLED IN BY THE/ BUILDING DEPARTMENT)
5. Existing Use of Structure/Property `✓I ff
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 KN0,1A v 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 ES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained ,date issued:
(FORM CONTINUES ON OTHER SIDE)
File#BP-1999-0802
APPLICANT/CONTACT PERSON O'BRIEN ROGER S JR
ADDRESS/PHONE 136 ACREBROOK DR 584-8473
PROPERTY LOCATION 136 ACREBROOK DR
MAP 29 PARCEL 224 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid /,/
T_ypeof Construction: 12 X 16 SHED
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
VApproved as presented/based on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed=ice_
Finding Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § —w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservatiod ommission
Signature of Building Official Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
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136 ACREBROOK DR BP-1999-0802
GIs#: COMM ALTH OF MASSACHUSETTS
Map:Block:29-224 Y OF NORTHAMPTON
Lot:-001
Permit: Building
Cate o :alteration-addition BUILDING PER •_IT
Permit# BP-1999-0802
Project# JS-1999-1434
Est.Cost:$1600.00
Fee:$20.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group:
Lot Size(sa ft.): 14897.52 Owner: O'BRIEN ROGER S JR
Zonina:URA Applicant:_
AT''13s-ACREBii00K DR
Applicant Address: Phone: Insurance:
ISSUED ON.41611999 0:00:00
TO PERFORM THE FOLLOWING WORK:12 X 16 SHED
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings '
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Final: Final:
Rough Frame:
Gas Fire Department Fireplace/Chimney:
Rough: Oil• Insulation:
Final: Smoke: Final: B k
THIS PERMIT MAY BE REVOKED BY THE CIT F NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occ /01 i nature•
Fee Type: Receipt No' Date Paid: Check No: Amount:
Building 4/2/1999 0:00:00 $20.00
212 Main Street,Phone(413)5 ax:(413)587-1272
Building Commissio„ ony Patillo
MORTGAGE LOAN INSPECTION
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I hereby report that the premises shown on this plan is not located within a Flood
Hazard Area as shown on Department of H.U.D. Federal Insurance Administration Maps,
Community Nu_Mber 250167 0001A
Identificatiph DAte April
By: <
TO THE FLORENCE SAVINGS BANK OWNER#
ESTATE OF MARY F. O'BRIEN
A140 THE FIRST AMERICAN TITLE INS. CO.-ONLY LOCATIONi
To the best of my knowledge, informa- 136 ACREBROOK DRIVE FLORENCE
tion and belief, I hereby report that I ALMER HUNTLEY JR. k ASSOCIATES INC.
have examined the premises -and that this . • '
inspection plat shows the improvement or SURVEYORS -ENGINEERS LANDSCAPE ARCHITECTS
improvements as located on the premises de- 30 INDUSTRIAL DRIVE EAST P.O. BOX 568
scribed, that the improvement or improve- NORTHAMPTON,MASSACHUSETTS 01060
ments are entirely within lot lines, and
that there are no encroachments upon the SCALE,
premises described by the improvement or �NOF 1 =30
improvements of any adjoining premises,
except as indicated. I further report that DOUGLAS DATE#
-there are no easements of record affecting W
the tract shown hereon, except as noted. THOMPSON F7s-69..>A2y 9 , "158
'PfcaTE ° JOB NO.:
ZOO L 8 8 19
THIS PLAT IS FOR IDENTIFICATION PURPOSES ONLY AND DOES NOT CONSTITUTE A PROPERTY SURVEY