35-209 (5) z
T A
D m
vDi
cv
r v, O
a
Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
--fi. Location -L3 j 6V J ig aAlo c�, �d r�`2 M"j-r2�. l�'t- Lot No.
--T.-Owner's name 1-eel iLk Xj VXY-rd t_vs _ — -- Address 6 M X` LNpfir, DA aU470k
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
Addition G a 17 4 VW-12
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
L,44Estimated cost-
30 0
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
ignatu�of responsible app icant
Remarks
150 ' Frontage
HANDICAP ACCESSIBLE
_ 4
RAMP
l
48 '
Permit Request for,
N 49 '
House 531 Westhampton Rd
i2 A 29 ,
Florence, MA, 01062
250 ft 591
171 '
Stream
SITE LAYOUT
O�.C11Aa1P�0 I
u` £1�zf� of wort 17a»lptalT
x AitSOHclln0rIto
°n' m 2 Q @%EPARTIv1ENT OF BUILDITjG INSPECTIONS
NSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
/ ( Please Print )
DATE: �l� '�{
JOB LOCATION:
(Map) ( Parcel ) ( Subdivision)
HOMEOWNER:
(Name & Address )
( 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
O`_ C c.11 0-n LO?"m ?C l � CG t!1 U_l�i 1=g �Lf1Clc.l that he/she
SIla1 be ' eSYDOr1SlDle -Or -all SL1c.L� ',JOr}-. 0rI11 C1 under the JL111d1 �
n
As acting Construction Supervisor your presence on the job site:
wi11 be required frorn time to time , during and upon completion of the
wor'.-_ 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
BUILDING PERMIT
O4� TO
r x of ar ant tuts
DEPT 01
�asaRClTnsctta
I7EPAR ENT OF BUILDING INSPECTIONS "
W 212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S C0_KPENSATION INSURANCE AFMAVIT
Y ro ul
(liceuserlpermittee)
with a principal place of business/residence at:
6-3 GL'�:s t,v-1t
(strcri/cz ty/stateJzi 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 worlQng on this job-.
(Inszuanc;2� ampauy) (Policy Number) (Fxpiration Date)
( ) I atn a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the follo1.ring worker's compensation policies:
--- (Na 11C OI co'm—actor) -- —(tll� '.C:; i��OIiiD3i7J!POtICr �lIiI1C��;) -- (1-x ir oll Da 1c)
C_cIImal on Data)
(Name of Contractor) (Insurancti Comp".IIyiPolicy Number) (Expiration Daie)
(Name of Contractor) (Insurance Compauy/Poticy Numbtr) (Expiration Date)
(attach ad&6on2l ihcct ifncccr to inGtudc Lslxmr tioa pertaining to all
( ) 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 that wrsilc hoaieo ADcn«'uo e zploy pexiam to do mai..tcaa,f t pa a worse on a dwce g of
not morn than throo units is w1hich the bornoo-Ama residcs cc oo the grouuds appu rte vnt the do art not homily oow'dacd to be
cmploycrs under 6a worka`s oompassaticn Ad(GL 152-"1(5)),application by a homeowner for a Gccax cc permit tnay cvidcnoc the
legal ctahus of an omployoc under tho Woricce,Compenvtion Act_
I understand dDd a copy of this ctslcmmi m►y bo fb��-rdod to tbo DcV tmca2 of IM,,tri11 Accidmb'Ofd of Irnxuioco for tbu
covaxge vcrificatioa and that faA=to ur c=cov=r o undcs section 25A of MOL 152 can lead to tho im{os On of aims w pcnalEcs
coasuBag of a fmo'of up to S 1,500.00=Nor impti ncai of up to ane year And civil p=anics in the form of a Stop Work Order and a
fim 0(5100.00 Idly against ma_
Foe degrat Zl- t erne only
Permit Number
_�t'�'� �„' '+-�•':J Maplt _Lot#
Sigmaturo of Li' rnuttee
- i•
i
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 tl
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This cols to be filled in
by the Banding Department
Required I
Existing Proposed By Zoning
Lot sizer
/Y
Frontage �-
Setbacks frnnt
- side L: VO R: 5d L:- R:
- rear r
Building height
Bldg Square footage 15, �6
%Open Space:
(Lot area minus bldg
&paved 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.
DATE: �,� `(� y APPLICANT's SIGNATURE _E' �vt. c �
NOTE: issuanoe of a zoning permit does not relieve an ap icant's burde t comply wit" all
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission, Department of Publio Works and other applicable permit granting authorities.
FILE #
AUG Z 41998
{s, File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: l.eOYUN'j yayr'v�S
Address: .�'3( jV 0V1 Telephone: a 6
2. Owner of Property: 4e,,s ,u,-y j y�Y,rd�f
Address: S3( C0¢576waK rRJ , NDyAa)jsA a,& Telephone: 5'9 fc X16 �E
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: 0( Wa57-ha uts/lo 11� Rd ffdV'A a!!_�
Parcel Id: Zoning Map# 3 Parcel# 010 District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property r.�e & iJz "Le-,-
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
/fa►��Ca Ac c��s�(,x rz ,�a►�✓9
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 c/ 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-1999-0230
APPLICANT/CONTACT PERSON Leonard Yarrows
ADDRESS/PHONE 531 Westhampton Rd (413)584-2626 0
PROPERTY LOCATION 531 WESTHAMPTON RD
MAP 35 PARCEL 209 ZONE SR
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: Q
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Occupant Statement or License#
3 sets of Plans/Plot Plan
TH OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved 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
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
®r " ik
e � C .x
Signature of ui i 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-1999-0230
Department: ...................................
Building,Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No-,
Building- Renovation REC-1.999-000494
.........................................................................................
Paid By: Pa.id..i.n.F......u I I 0.n:...........
Leonard Yarrows Tue An-2.5 3 1998
...................... ra
Re ...................................................................
.. . ...... ......
ceived By: .Check. . .No:................
.Linda Lapointe MONEY ORDER
.........................................................................................
......................................
DEPARTMENT'S COPY Amount: $20.00
...........................
1)["PARTMENT FILE COPY 531 WESTHAMPTON RD
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-1999-0230 $20.00
GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size:
7026 35 209 001 531 WESTHAMPTON RD SR 66646.8
Contractor: License Type: Insurance:
Homeowner as Contractor
Address: License No.: Insurance No.:
LiLE State: Zip Code: Phone:
Pro 6ect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0421 alteration-addition $300.00
Description of Work:
CONSTRUCT TEMP HANDICAP ACCESS RAMP
GeoTIVIS@ 1997 Des Lauriers&Associates,Inc. Signature: