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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No '�) y-1333 Alterations
NORTHAMPTON, MASS. 197 5 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location 5(✓ ��t G �. 7 a�r s r r u Lot No.
2. Owner's name -�c : �. ,� 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 4, `� r V e t- j; ,v c� tf� f .:�,� j'r�=rL ou-
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
Signature of responsible appicant
Remarks
t � t
y _
� 9 �asaxcEfnsctta
OCT 6 1998
PARTMENT OF BUILDrNG INSPECTIONS
Q�t 12 Main Street ' Municipal Building
• i
Northampton, Mass. 01060
WORKER'S C0?',TPENSA'n0N INSURANCE &FFMAVIT
— (li tens,°cJ permi tt ec)
with a principal place of business/residence at-.
r-t -«� ✓� �r�l� (Phoney#) S S'y—! 3
(strt"t/ci ty/stn-trla p)
do hereby certify, under the pains and penalties of pegUry, that.
( ) I am an employer providing the follo,,ving worker's compensation coverage for my
employees working on this job.
(Instrrance Company) (Policy Number) (Expiration Date)
er
I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's tom p P ensation oficies:
(Name of Contractor) (Insurancc Comoany/Pohcy NtmnlYr) (Ezpimtaon Date)
(Name of Contractor) Insurance Company/Pohc-;Numb_'r) (EKpiratlon Date)
(Name of Contractor) (lasuranc_— Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insuranct Compaily/Policy Number) (Expiration Date)
(ml,,I,additional shcct ifne aczsry to include information pertaining to all cccftracton)
( I am a sole proprietor and have no one working for me.
( I am a home owner performing all the work myself.
NOTE:plcasc bo awarc thst whilo homcowacrs wbo cmploy persons to do mahatma coastrucuoca or repair work ou a d%%,I ng of
aot moc•o than throo runts is which the by,?�v�rc idn or oo the grounds apputtcawi the cto arc oot gcaxrally eoasidcrcd to be
cmployors uDdcr the wockcr's oomper 4on Act(GL152_=1(5)),application by a homcow=for a licarsc Of permit mey cvidcaoc the
legal etahrs of an employoc under tho Workces Compooaxtioa Act.
I undcrtund that a copy of this rt3 f cmcm may be foams ur iod to the Dtpcutmcar of a,,t ill Amdco&Orlioo of Inaurwoe for the
covaxge vaifimiioa and that Kathryn to sea=covcrngo tn�dcr sociion 25A of MOL 152 can lid to the impost -of crimmsl penaliia
oomistma of a f nc of up to s 1,5 0.00 anNoc of rip to o=yar and civil pen LWC$in tb4 form of a Stop Work tOvdcr and a
find of 5100.00
0-Y tne.
Foe dcpartm l ui°only
,4�` r , Permit Number
I&p# Lot#
Sigitatart�ofLiccnvice!)?ermit�ce
X998
r +� OCT 6
�
7:77 3DEP RTMENT OF BUILDING INSPECTIONS - '
DEPT OF BUILD!�'G MS x , ")
INSPECTOf2aro NORTHA�TKO' k'ACI ! 2 Main Street - Municipal Building
Northampton, Mass. 01060 M
HOMEOWNER LICENSE EXEMPTION
_ (Please Print)
DATE•,*' _ mil`sf
JOB LOCATION: 4 I H CE_ r id + ct C N `
(Map) (Parcel) ( Subdivision)
HOMEOWNER: S T� c ti> -
(Name- & Address ) ,
(Hdme 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 _-� t
BUILDING PERMIT # ;>
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 cola= to be filled in
by the Banding Department
Required
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
&Pax,ed parkingi
# of Parking spaces
f of Loading Docks
Fill:
4vo1-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
APPLICANT'S SIGNATURE /
NOTE: Issuance of a zoning permit does not relieve an applioant's burden to oompty witl)-all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appiiooble permit granting authorities.
FILE #
DEPT 0V Fi2allo
NO
�� ��� �� � �
=�==�== � ====~� == � ====���=, « �r�� ~ ��
PLEASE TYPE OR PRTWT ALL ZWFORMATION
'
1. Name of Applicant:
Address:
2. Owner mtProperty
v/
AddressTelephone:
3. Status wfApplicant: ' Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning K8ap District(s):
(TO BE FILLED |NBY THE 8U|LD|NGDEPARTMENT)
5. Existing Use ofStructure/Property
G. Description of Proposed Uae/Work/Projeob\]ooupoUon: (Use additional sheets ifneoammory):
—�-
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed P1ono
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
B. Has a Special PornnhfVohnnoe/FindinQ ever been issued for/on the site?
NO DON'TKNO 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
_
S. Does the site contain e brook, body of water orwetlands? NO vz' DON'T KNOW YES
UF YES,has a permit been or need toba obtained from the Conservation Commission?
Needs tobeobtaine Obtain .date issued:
(FORM CONTINUES O0 OTHER SIDE)
Reference No: BP-1999-0366
Department: ...................................
Building,Electrical & Mechanical Permits
Fee Type: Receipt No:
Roofing REC-1999-000959
......ia 6�. .......................................................................... ...... ...............................
Pq Paid in Full On:
Grace Straw Wed Oct 07,1998
.... ....... ... .... •............Received By: C h eck
No:...................
Linda Lapointe 265
.........................................................................................
......................................
DEPARTMENT'S COPY Amount: $20.00
...........................
DEPAR,rMEN1' FlLE COPY 36 GILRAIN TERR
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: Trackine No.: Fee:
07 Oct, 1998 BP-1999-0366 $20.00
GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size:
4781 29 054 001 36 GILRAIN TERR URA 14810.4
Contractor: License Type: Insurance:
Homeowner as Contractor
Address: License No.: Insurance No.:
9tu State: Zip Code: Phone:
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0740 roofing $1,200.00
Description of Work:
SHINGLE ROOF OVER I LAYER
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: