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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
A
V,1" � (Z) �ZG Lot No.
L/21 Owners name 4 �e u �ess 1/ o GJ rq eu
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
13. Siding house
,—i-4-lhs6mated cosc:-
'ed coo - The undersigned certifies that the above statements are we to the best of his.
knowledge and belief, -
0 Signature of responsible app.icani
Remarks
•�O4 C1�MP�O� y
� 8 v � � ,�iixeeatl�ueette -.
DEPARTMENT OF BUILDING INSPECI•IONS
INSPECTOR 212 Main Strcet ' Municipal Building '
Northampton, Mass. 01060 a`'a•
HOI-M-OWNER LICENSE EXEMPTION
(Please Print )
DATE: �G%�� r •�
JOB LOCATION: 11 ��d•t ��� ��� A
(MaAp Parcel ) ( Subdivision)
HOMEOWNER: G€'r JIA'✓t 144
(Name & Address)
(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
conside.red 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 bui-idipq
permit'.
As acting Construction Supervisor your presence on the`• j.ob 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 responsibi-'lit-
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. PEAZMIT # :1s
;; Crift d Aral 4xnt���n
03 3 1 I�� �la�r:ctiasclli
DEPARTMENT OF $UILDBgG INSPECTIONS
212'Main Street ' Municipal-:Building
Northampton, Mass. 01060
WOMCER'S COMPENSATION INSURANCE AFFIDAVIT
. (licelLSCrlpermittix) .
with a principal place of business/residence at:
l f�C (phone#)
do hereby ce , under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Datc)
( ) 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 Contractor) (Insuran=Company/Policy Number) (Fxpirnti on Date)
(Name of Contractor) (Insurance Company/PoGcy Number) (Expiration Date)
(Name of Cmit actor) (Insurance Company/PoGcy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
0--h sdditioml abort ifnooc=s ry to 6ch4&inroctnatioa pertziasng to.11 ooa!neton)
( ) I am a sole proprietor and have no one working forme.
I am a home owner performing all the work myself
NOTE:plcsx be atvarc th:t w'hilo homeowocn wbo axpl oy priori to do nom•i•.g,•,,,a cocst c owor repair work oa a dwelling of
not mote thaw tbrvo toaita in which the bomoowner rvaidca«oa tbo avuacca Tpu tal"A tba,,to arc not grnaalty co=Wcrvd to be
amploytra under tbo wvcfc ex compcnset ea Act(G L152,=1(5)�application by a homeowner fer a licc ox or pc=d Reny evidence tbo
Itvi tasu or*4 oe ploy.t under the Woclrota comp.oa.tiota Act.
I nods u;.d th,a a copy of thU etatommt ouy be focw.,d.d tt.tb.DV tmont.fLadsuerid A-W—&Of —of Lournno•fa d-
*WmaavrrMedied ttad tbat fad to rocwe covcrav under zoWca M of MOL 152 ran lad to the imposition of cr;mk+lpenalde, .
000siabcs ors.Sine ut`up to S 1,500.00 aadlor 6{16orm0c%A of tip to one yr.r mod ciQ pcanhict is the form of a Stop Work order and a
Rico of5100.00 a day&picA mw •.
. � Fordcpa�+r�allwooly
Pc mit Number
•U �' Mao Lot 0
a5 x. Signature ]LiccnscclPcrmittcc `
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10. Do any signs exist property?rh r? 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.
Thts cols to be filled in
by the pudding Department
Required
Existing Proposed By Zoning
Lot size J� .t� ,� L 3 D'cv<
/as
Frontage
Setbacks
u
- side L: R: L:as-5'tR:
- rear
d
Building height a�
Bldg Square footage O?d q
%Open Space: C 51t
(Lot area minus bldg [/ !/S 3 6,9�/q
JGnaL/gd park1-n i
# of Parking Spaces
#` 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.
ILPOLICANTs SIGNATURE
NOTE: Ise nn a of a zoning ermit does not relieve an app i nt's burden to oomply wltl� .all
zoning requir ments and obtain all required permits from th oard of Health, Conservation
Commission, Department of Publio Works and other appiloable permit granting authorities.
FILE #
i ivv" 1 `'` Fi 1 e No. 9, P00 Q 3
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 6/�� ��
Address: // G :1,1' t°✓ 1,11A Telephone:
2. Owner of Property: Pt° r Au '� GP e �)��/ �/G'
Address: �! za//v<// g/9Ar Ad/? e Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Ld
Parcel Id: Zoning Map#� Parcel#_ _ District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property �s F)�
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
r
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the fonowing 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 yyto/� be obtained from the Conservation Commission?
Needs to be obtained �Vj P- Obtained ,date issued:
(FORM CONTINUES ON OTHER SIDE)
File#BP-2000-0223
APPLICANT/CONTACT PERSON DANIELLO PETER R&MARY LEE
ADDRESS/PHONE 11 LADYSLIPPER LN 586-9909
PROPERTY LOCATION 1 I LADYSLIPPER LANE
MAP 35 PARCEL 249 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
Typeof Construction: ERECT 12 X 16 STORAGE 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�LLOWING 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
Permit from Conservation Co ion
Z
Signa uilding O 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.
11 LADYSLIPPER LANE BP-2000-0223
GIS#: COMMONWEALTH OF MASSACHUSETTS
MV-Block:35-249 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: shed BUILDING PERMIT
Permit# BP-2000-0223
Project# JS-2000-0362
Est. Cost:$2500.00 `
Fee: $25.00 PERMISSION IS HEREB Y GRANTED TO:
Const. Class: Contractor: License:
Use Group:
Lot Size(sq. ft.): 45302.40 Owner: DANIELLO PETER R&MARY LEE
Zoning: SR Applicant:_
AL- 11 LADYSLIPPER LANE
Applicant Address: Phone: Insurance:
ISSUED ON:91211999 0:00:00
TO PERFORM THE FOLLOWING WORK.-ERECT 12 X 16 STORAGE 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:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Sianature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 9/2/1999 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo