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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. J-14, / 7 ,/ Alterations
NORTHAMPTON, MASS. glr- ` !O 19 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location Lot No.
2. Owner's name Address
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration �? �r,��' C3-19- t�.r .It n2 / a y/2 c�{.. l7i ve2 fig
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 cosL- �t va �rp 3, bOJ
The undersigned certifies that the above statements are we to the best of his, her
knowledge and boAef.
pa'sr
Signature of responsible appiicant
Remarks
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SEP 811998 '
CITY OF NORTHAMPTON
BUILDING PERMIT CHECKLIST
All 1&2 Family Proj eCts The following items are to be
considered MINIMUM
information to be submitted with ALL permit applications
Address: G , 4�;L�
A Scaled drawings & detail shall be submitted with each application proposing
construction, reconstruction, addition, alteration, or repair. The building official
may waive the requirements for filing plans when work is of a minor nature.["
B. Scaled drawings & details shall indicate & describe all proposed work, including location,
size, grade of materials &equipment to be used. [-]-
C. PLOT PLAN, property address; map & lot number, zoning district & overlays (such as
wetlands) [ ]
Show well and septic locations (if applicable) ( ]
Location of lot lines, dimensions of lot, frontage [
Location &dimensions of public easements, public utility easements, railroad right of ways
, and established zoning setback requirements. [ ]
Locations & dimensions of primary and accessory buildings & strictures. [ ]
D. FLOOR PLANS, floor plan of each floor and intermediate levels including basements,
crawlspaces, terraces, porches garages, carports, and decks, showing existing condition and
proposed construction. [tom'
Dimensions, locations (�, materials of foundations, Footings, columns & piers {including
reinforcing when rcquircdi [
Direction, dimensions, spacing (L grade of all framing {floors. roofs, "%-ally, partitions} [
Location of all walls, partitions, windows, stairs & doors [ �
Location & description of all electrical equipment , alarm devices and smoke detectors [ ]
Location & type of all heating and air conditioning (HVAC) equipment. [ ]
HVAC schematics (where required check with building inspector) [ ]
EXTERIOR ELEVATIONS, Front, rear & side elevations including foundation and finish
grades. [ ]
Location & dimensions of windows & doors. [ ]
Description of exterior cladding or siding material. [ ]
Show exterior stair locations & dimensions. [ ]
Show chimney and vent locations [
DETAILS & SECTIONS, Sections through exterior walls showing details of construction
from footing to the highest point of tho building. [ ]
Sections through fireplaces & chinunc�ys (show clearances) [ ]
Location &details of any roof trusses, glue-lam, or engineered lumber (include connection
details and Massachusetts professionals stamp on specification sheet) [ ]
Exterior envelope ener�!v requirerents : Uo-of walls, roof-ceiling&floors ..OR.. R value of
walls/roof/floor, also percent of window area to wall area. [ ]
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SEP
,. DEPARTMENT OF BUILDING INSPECTIONS
DEPT O, tt 212 Main Street ' Municipal Building '
Northampton, Mass. 01060 y
WORKER'S CONTENSATION INSURANCE AITMAVIT
jl censer-lpermi ttce)
with a principal place of bus' ess/residence at.
(phonet#)
(str�ci ty/st a tdzi p)
do hereby certify, under the pains and penalties of pegury, 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,
(Name of Contnctor) (Insurance Compan�,/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Como alry/POlicy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expymdon Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sbx ifncccauy to iaclu6c information pataining to all ccafrndors)
( ) I am a sole proprietor and have no one wor4dng for me.
-(4) I am a home owner performing all the work myself.
NOTE:please be aware that whilo homcoµum wbo asrplay pervam to do *i„t�coastrucU-or repair worts on a dwelling of
not mono than throe units in vArch the homoowncr rcaidea or oo the groin apWrteIISBt thacto arc oo(generally w='dacd to be
employers under the work&%compers4on Act(GL152,=1(5)),application by a homeowner for a UccO-34 cc permit may widen-the
legal etshrs of an employer under tho Woricoes compax&A ion Act
I undcra ad that a copy of this ctat--f MAY bo forwarded to the Departs A of Industrial Acci6w&Ogee of 10v,"xnc0 for the
coverage vcrificzt oo and that failure to wane covcngo under section 25A of MOL 152 can field to the'imposition of criminal Pcaallics
ooanstiag of a fmc of up to S 1,500.00 wNor imprisotrfficat of tip to cm yrar and civil peenIdes in the form of a Stop Work Order and a
fi0.00 a cla against me
-
of
1 trio oa1Y
mber
Lot#
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� Cp yy�1 C)t, PARTM NT OF BUILDING INSPECTIONS
.NSPECTOR f�ORTHA��HOJ FAN D Street ' Municipal Building '
Northampton, Mass. 01060
I HOMEOWNER LICENSE EXEMPTION
14 9 ( Please Print)
DATE: ,
JOB LOCATION:
(Map) (Parcel ) ( Subdivision)
HOMEOWNER: k
(N me & ddress )
(Home Ph ne) (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
Dermit .
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
CIJ
BUILDING PERMIT #
F
} F
10. Do any signs ebst 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:
II. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This col u= to be filled in
by the Building Department
Required I
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt `
- side L:��R: v L: R:
- rear
Building height
Bldg Square footage J
%Open Space:
(Lot area minus bldg
&paved parking)
# of -Parking Spaces
#tof Loading Docks
Fill:
(vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accura e to the best of my knowl ge.
DATE:
APPLICANT's SIGNATURE ,
NOTE. uanoa of is zoning permit does not relieve an Appiloafirs burden to oomply with .4111
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applionble permit granting authorities.
FILE #
i
a SEP 8 998
_e._v.... Fi 1 e No. If"
�FE
. ... ,PING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 1/
Address: Telephone: 1�7 _
2. Owner of Property: C* j
Address:-24) oWl , )G!1a-.,—Telephone: �{_jk- 1
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: h) '/f, G� T, �g -
1
Parcel Id: Zoning Map# Parcel# �`,S District(s):
(TO BE ILLED IN BY THE BUILDING DEPARTMENT)
----.._--------_�_ --
5. Existing Use of Structure/Prope
6. Description of Proposed Use/Work/`Pr roject/Occupation: (Use additional sheets if necessary):
Gc 4 /. Q IIAGICG .;, `c/ lam/ u13Ih c1= /hlhe -4/)-
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.
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO !-' DON'T KNOW 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 ,date issued:
(FORM CONTINUES ON OTHER SIDE)
File#BP-1999-0279
APPLICANT/CONTACT PERSON Paul Smith
ADDRESS/PHONE 16 Holly Ct 413)586-1784 0
PROPERTY LOCATION 16 HOLLY CT
MAP 29 PARCEL 095 ZONE URA/WSP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid -"
Type of Construction:
New Constructions
Non Structural interior renovations _ -
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Occupant Statement or License#
3 sets of Plans/Plot Plan -�
THE LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presentedibased 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
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
� � � �1$� �1+t ` I�' f► Well Water Potability Board of Health
Permit from Conservatio ommission
Signature of Buildin icial 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.
Reference No: BP-1999-0279
Department: ...................................
Building,Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Building-Renovation REC-1999-000679
.........................................................................................
Paid By: 'P'a'id...i,n*...F...u'll...0...n":...........
Paul Smith Tue Sep 08 1998
.......... ....
eceived By ......................................
Check No.-
Linda Lapointe 3881
.........................................................................................
......................................
DEPARTMENT'S COPY Amount: $52.00
...........................
DEPARTMENT FILE COPY 16 HOLLY CT
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: Tracking No.: Fee:
BP-1999-0279 $52.00
GIS #: Map Block: Lot: Address: Zonin2: Use Group: Lot Size:
4821 29 095 001 16 HOLLY CT URA 12980.88
Contractor: License Type: Insurance:
Homeowner as Contractor
Address: License No.: Insurance No.:
City: State: Zip Code: Phone:
Pro iect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0589 alteration-addition $13,000.00
Description of Work:
CONVERT GARAGE INTO LIVING&DINING ROOM
GeoTIVIS@ 1997 Des Lauriers&Associates,Inc. Signature: