36-003 (3) DEPT O $U Lpl,d IMSPECTiQNS
R Vtr
NORj N Q1t16i?
�f
uo �
�t
hews e.
cqc
1
i
O O m., Z
n
F
a t (Az
> --3
o �• 0
rD
Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
%
' APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location ) Lot No.
2. Owner's name Address to &
3. Builder's name Address 1,7
Mass.Construction upervisor's License No. S ��� 7 7- Expiration Date 04 /It
4. Addition
S. 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
14, stimated cost:-
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
Signature of res onsib(e appicani
Remarks .+OAK. i✓ c..�.B �/j�v vas-E'se
aK ��
R'a
of Nara aillp#att
+ L U Se 2 0 I999 essncf�uaette
DEPARTMENT OF BUILDITIG INSPECTIONS
DEPT
INSPECTOR hOTHia 'T('" k GI � ttin Street ' Municipal Building '
w � •,,•
orthampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
DATE; ���� /
gf (Please Print)
JOB LOCATION: 6 — 3
(Ma (Parcel) ( Subdivision)
HOMEOWNER: p�J'L-
me & .ddres
)
e1 g -L ?I%.
(Home hone) (Work Phone)
The current exemption for "homdowners" 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: Persons) 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 responsibi-lity '
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 #
:
l '
Crzt� oaf 'Wart amptan
L
9 S& 20 � �l:saxcaus-tta
m
—DEPARTMENT OF BUILDING INSPECTIONS
1Main Street ' Municipal Building '
Northampton, Mass. 01060 '
WORKER'S COMPENSATION INSURANCE.AFFIDAVIT
�, G'wwP.lJ
(licensee/permitt�e>
with a principal place of business/residence at: n
10 lit�'Jrt .c-w e (phone#) J �/-6 A!
(st U6ty/sla0zip)
do hereby certify, u-oder the pains and penalties of perjury, that
O I am an employer providing the following worker's compensation coverage for my
employees working on this job:
6.joe44 44 l-660-360IV?101A o� 1s
(Insurance Company) (Polity Number) undo 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 Contractor) (Ina=(-- Company/Policy Number) (Expirntion Date)
(Flame of Contractor) (lnsuranc:, Compauy/PoLicy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additioml>hOd if noocasry to iac}ude issfurtnaIIoa pertaiaing to.11 ooat ndon)
( ) I am a sole proprietor and have no one woriang for me.
( ) I am a home owner performing all the work myself.
NOTE:please be awuc that wbila hoa=%vocrs who employ persoa:to do mamicunoe c=ovaimor rcpas work on a dwelling of
not-store*thaw tbm unit:is which the hogwawnca'tcsides or oath,grounds spptttteaaaat-beet%arc oot grao�ralty ooa:iticzzd to ba
c-Ploytira under the-%-ice`s.=wcas c a Act(GL152,ss 1(5)�aWticzdon by a homcownir for a license oc permit may evidence the
legsl status of an employer under tho Wocicoes compomatioa Act
I madeastiad dul a o%py of this chlamml may be fammrdod to ti?a Npactaacot of lndaaL d AeadW Olfioo of Iawn°aa far the
eovernga verification amd that failure to sec=coverage under soctioa 25A of MGL 152 art kad to tbo is on of aiminal peed b-
000iitQag cf a-fm bf up to$1,500.00 amdloc kVrisoam of tip to one year and civil pemltia in the form of a Stop Worts 0tdee and a
mm of 5100.00 a•day apiaA sty
Foc d1 uao oaly
Pcrmit Number
_Lot#
Si of Li ermines
10. Do any signs exist on the property? YES NO L/
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES NO--Z
IF YES,describe size,type and location:
11 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This C01n= to be fi2led in
by the Fluilding Department
I Required
Existing Proposed By Zoning
I Lot size r7 31 1 c�Q� Goo
Frontage ) G
Setbacks '
- side L: 0 0C R:� L 6:Z R: 1`
"T
- rear
-e-2 �etj
Building height
14- C7;
Bldg Square footage 30
%Open Space:
(Lot area minus bldg j .r o
&paved parking)
# of Parking spaces
# of Loading Docks
Fill:
-(volume--& location)
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
DATE: APPLI 'Gf
CANT's SIGNATURE
NOTE: Ion a oe o a zoning permit does not relieve an plioanYs burden comply With ill
zoning requirements and obtain all required permits from the Board of Health. Conse+rvtmtion
Commission. Department of Publio Works and other applionble permit granting authorities.
FILE #
r
y SEP 2 0 199q File No. P 03
z I
d
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: `/
f& 6
Address: ✓ r1' " elephone: 3Z �7�
°
2. Owner of Property:
Address: elephone: —,�'??P.
3. Status of Applicant: Owner . Contract Purchaser Lessee
Other(explain):
4. Job Location: j o
Parcel Id: Zoning Map# �0 Parcel# District(s):�
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description Description of Proposed Use/Work/Project/Occupation: (Use additional)sheets if necessary):
T 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 V'. DON'T KNOIA' YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO L/ 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 'y 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-2000-0312
APPLICANT/CONTACT PERSON FOLEY JAMES V&COLLEEN B
ADDRESS/PHONE 10 FOREST GLEN DR 584-6370
PROPERTY LOCATION 10 FOREST GLEN DR
MAP 36 PARCEL 003 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildina Permit Filled out
Fee Paid " 5 7
Typeof Construction: CONSTRUCT 18 X 12 STORAGE SHED
New Construction
Non Structural interior renovations
Addition to Existing
Accessoa Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE�LOWING 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 ission
�j
Signature o Building Official 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.
P w
10 FOREST GLEN DR BP-2000-0312
G1S#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:36-003 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: shed BUILDING PERMIT
Permit# BP-2000-0312
Project# JS-2000-0496
Est. Cost:
Fee:$50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group:
Lot Size(sg ft.): 15333.12 Owner: FOLEY JAMES V&COLLEEN B
zoning:URA Applicant:_
AL. 10 FOREST GLEN DR
Applicant Address: Phone: Insurance:
ISSUED ON:0912311999 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 18 X 12 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 Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 09/23/1999 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
M�N � �
a F -
10 FOREST GLEN DR BP-2000-0312
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-003 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:shed BUILDING PERMIT
Permit# BP-2000-0312
Project# JS-2000-0496
Est.Cost:
Fee:$50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group:
Lot Size(sq.ft1 15333.12 Owner:_FOLEY JAMES V&COLLEEN B
Zoning_URA Applicant:
AT: 10 FOREST GLEN DR
Applicant Address: Phone: Insurance:
ISSUED ON.•o9/23/i999 o:oo:oo
TO PERFORM THE FOLLOWING WORK:CONSTRUCT 18 X 12 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: 0 K'
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy i nature•
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 09/23/1999 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo