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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
�^ Garage
1. Location (CJ ( @2/-��.�! Lot No.
2. Owner's name Address
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
6. New Porch
I Is existing building to be demolished?
8• -pair after the fire
9. Gyge No.of cars Size
10. Men,of heating
11. Distanc,o lot lines
12. Type of rk �
13. Siding hour.
14. Estimated cost.
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
Signature of responsibl app'ican!
Remarks
® Crif� of wort 11a»iptell _ ,
$ 8 ��assacltusetls
z �
S" DkPARTMENT OF BUILDING INSPECTIONS
INSPECTOR. 212 Main Street ' Municipal Building
A
6 Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print )
DATE:
JOB LOCATION: /?I?
✓ (Map) (Parcel) ( Subdivision)
HOMEOWNER
(Name & Address )
Ll-
(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.
OMEOWNER SIGNATURE
BUILDING PERMIT # . .._
0gK t1AM p�O '�rFS[y
s a 6 `0, Crib -a Tax# �ttt rt z
� �><saiscETsrsctta
m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S COMTENSAUON INSURANCE AF MAVIT
I,
(liceruerJpermittee) —
with a principal place of business/residence at:
(phone#)
(strCi/cityh;t Lela P)
do hereby certify, under the pains and penalties of penury, that-.
( ) 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 sale proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insumnc:. Compaiiy/Policf Number) (Rxpim,Eon Date)
(Name of Contractor) (Insurance Conlpallvfpohcy Nl u nber) (Expimtlon Date)
(Name of Contractor) (Insurance CompaIIy/Pokcy Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date)
(attach aaaitioext sheet ifnocczsiry to includc mfwmitica pertaiain8 to all coati a n)
O I am a sole proprietor and have no one working for me.
( ) I am a home owner performing aH the work myself.
NOTE:please be aware that whilo homeowvera w{x:)employ per%oa=to do mxaii=�musty% ioa or rtpair work on a ckitding of
not mono than throw units in which the hoaxbowncr r=dc3 or oo the gxoua6 apputtenaat thccto arc not malty ooa ida d to be
employers under the workcr`a ration Act(GL152 ss 1(5)} application by a homeowner for a license or permit may evidcacc the
legzl rtatua of an employor under the Wocfda Compcmaiion Act
I understand that a copy of this ctatcmccd may bo forv.•m•ded to tbo Dcpermrnt of Iadwtrial Accidm4 Offioa of Irrnuwoe for the
coverage verification and that failure to acatre covcrngo undo soetioa 25A of MGL 152 can Icad to tbd imposition of criminal pcaaliics
oomi ting of a fine of up to S1,300.00 an&'or¢apt of up to one year and civil penalties in the form of a Stop Work Order and a
fim of 5100.00 a-lay against the.
For dgrattmenral—oaly
J r Permit Number
Nfap# Lot#
ZiVmbim f Liccnse&P' r Uce
_ t,
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:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This colamm to be filled in
by the Bnildiny Depisrf—nt
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paired parking%
# of -Parking Spaces
f of Loading Docks
Fill:
(vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
CA�PPLICANT's SIGNATURE
NOTE: luau a of as zoning permit does not relieve an appiioanre burden o oomph► wlttA .all
zoning requ rements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
FILE #
! ,
6 �
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
-�. Name of )
App�li/cant: '� - �-----
Address:
C _LG t"^G z-- ���'�— Telephone: 171 - 17 ,771
2. Owner of Property: J A m C
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map#_0,-9 Parcel#� District(s): L�w
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property :e/
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.
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 Dgcument#
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)
Department: Reference No: B.P-1999-0155
Building, Electrical &Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Roofing
.......... REC-1999-000308
Paid .........................••...........
Paid in Full On:
Mario Aprile
...............Y6.................................................................... Thu Aug 06 199
.. . ...... ......
Receive y: .Check. . .No:...................
Linda Lapointe 772
...........................................................
......................................
DEPARTMENT'S COPY Amount: $20.00
...........................
REPARTMEN't' FILE COPY 61 CAHILLANE 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: Tracking No.: Fee:
06 Aug, 1998 BP-1999-0155 $20.00
GIS #: Mai) Block: Lot: Address: Zoning: Use Group: Lot Size:
7004 35 187 001 61 CAHILLANE TERR SR 10018.8
Contractor: License Type: Insurance:
Homeowner as Contractor
Address: License No.: Insurance No.:
City: State: Zip Code: Phone:
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0257 roofing $4,000.00
Description of Work:
STRIP & SHINGLE ROOF
GeoTMS@)1997 Des Lauriers&Associates,Inc. Signature: