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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. aLf''�� Alterations
NORTHAMPTON, MASS. 194S_ Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location / (, :n LJt es&,- /err l !?Vt°i�z.E� /��� Lot No.
2. Owner's name Al in R"I,4,"', r
1r Address_
3. Builder's name ii rot e�r �,>S Address 71 Aj;Lj.�z,'- �7
Mass.Construction Supervisor's License No. Expiration Date
4. Addition tic
5. Alteration pi 1J
6. New Porch N(;
7. Is existing building to be demolished? Al a.
8. Repair after the fire
9. Garage Yr-3 No.of cars Size �V K P `
10. Method of heating � n
1l. Distance to lot lines 1`,,6jif ,'ar- g TYkr V11 FfpIJ
12. Type of roof NEI I e
13. Siding house
14. Estimated cosL-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible app!cant
Remarks
p 8 Coif oaf 'Hart aillpfan
� � .�iasaachuaetta
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01060 `
HOMEOWNER LICENSE EXEMP`T'ION
(Please Print)
DATE:
JOB LOCATION:
Map) (parcel) (Subdivision)
HOMEOWNER:
(Name & Wdress) _ J
(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 resided 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 m_ ay be' liable for persons) 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 AND SHALL BE ON THE JOB AS SUPERVISOR.
HOMEOWNER SIGNATURE
BUILDING PERMIT #
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 ,_
IF YES, describe size, type and location:
11 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK
OF INFORMATION.
This column to be filled in
by the Building Department
Required
Existin-g Proposed Bv Zoninci
Lot size /00, X /00' 16)0'
Frontage /D /00 '
Setbacks - front
- side L: R: L: R•
- rear
Building height r� /y,
Bldg Square footage
7V' a 75 ,
%Open Space:
(Lot area minus bldg
&paved parking)
# of Parking Spaces
# of Loading Docks
Fill:
(volume & location) ]
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
Date: 1- < Applicant's Signature:
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements
and obtain all required permits from the Board of Health,Conservation Commission, Department of Public Works
and other applicable permit granting authorities.
File No. K7�
ZONING PERMIT APPLICATION (§10. 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: j�& Q M qg.7' A iiei t q. mss
Address: J w 7 �ioiexTe(^ T-eeF- Telephone: -5-Y"9= 1 ��
2. Owner of Property: K ahls e'TA l si el H e ts.s.S
Address:-///G�L�G�%���u%� L, . v 2 Telephone: -5$
3. Status of Applicant: Owner *�` Contract Purchaser Lessee
Other (explain):
4. Street Address:
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
r
5. Existing Use of Structure/Property 4 Lr t ':r,.1 .10 s r^
q �. J
6. Description of roposed Use/Work/Projec ccupation: (Use additional sheets if necessary): /
r �
/-'O CX1i4Av6,(F 70 �oo��if/iyl
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)
FILL $
APPLICANT/CONTACT PERSON:
ADDRESS/PHONE:
PROPERTY LOCATION:
MAP PARCEL: �� ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ��
Fee Paid I/I
Type of Construction:
New Construction
Remodeling Interior / Addition to Existing r
Accessory Structure
Building Plans Included:
Owner/Occupant Statement or License $
3 Sets of Plans / Plot Plan
THE FO OWING ACTION HAS BEEN TAKEN ON THIS ZONING 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 from DPW
Permit from Consery tion Commission
_ Sign u e of BUfldlng Inspector Date
NOTE:Issuance of a zoning permit does.not relieve an applicant's burden to comply with all zoning requirements and obtain all required
permits from the Board of Health,Conservation Commission,Department of Public Works and other applicable permit granting authorities.
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m DEPARTMENT OF BUILDDA G INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE A TIMAVIT
(li censee/pertni ttec}
with a principal place of business/residence at:
� 4A tSl e� � , 'c•,� �� Ic_��� . (phone#) r,')1
(st-ccucity/sta 2e 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:
(jnsurance Company) (Policy Number) (Expiration Date)
O I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors fisted below who have the following worket's compensation policies:
(Name of Contractor) (Insurance Cornpany/Policy Number) (Expimbon Date)
(Name of Contractor) (Insurance Company/PoLcy Number) (Expiration Date)
(Name of Contractor) (Inswant CompanyiPolicy Numbu) (Expiration Date)
(Name of Contractor) (Insu=ce Company/Policy Number) (Expiration Date)
(attach additional s_hcci ifnto icy to iaformitioa patnining to'H mdraciors)
i
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 whi]c hocxnwncta who cmplay pczt n to(10 repair wovk on a dµttling of
not mere than throe units in kfrich the hoar- —acr rctides a oo the gvin i,appurtecLU t th�tto I ax g'ncr-tUY coes;' a1 to be
catploycrs under the Ve0ek is cernpcnzatim Act(GL152,"1(5)),application by a honicowna for a Lcc—a pcflnil may evidrno`the
legal�txtus of an employes under the Workcet Compamation AcL
I un&=e-,nd that a copy of this Kt rc,cL may be lbrwwded to the Bcpa in of rn&utrial Aocidas&Offroo of Inziu.ncn for'ho
covaiage verification and that failure to seauc coverago undx sccuoa 25A of MOL 152 can Icad to thti itnposirion of criminal penalties
ooasiatin of a fine of up to S1,500.00 and/of imprisoamcat of up to one year and civil penattia in dl[I'M of a Stop War'Ord--and a
find of S 100.00 a day against me
7 Fof dc¢uRir 'I isle°°ty
Permit Number
t Lot 4
v Signature of Liccnse Crmittce e
SECTION 8-CONSTRUCTION SERVICES'
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
1 4—
Signature Z4 Telephone
Reel"�tered Hom`"zImprovement'Contractor:. .��" �,,,, E,•� ^ {f.... Not Applicable [I
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS';COMPENSATION INSURANCE AFFIDAVIT(M.GL.c. 152, § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... ❑ No...... ❑
Owner Exein i n
The current exemption for"homeowners"was extended to include Owner-occupied Dwellinp_s 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. CMR 780, Sixth Edition Section 108.3.5.1.
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, J to a d Local Zoning Laws and State of Massachusetts General Laws Annotated.
r
Homeowner Signaturet
SECTION 5- DESCRIPTION=OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ ReplacemenyWindows Alterations) ❑ Roofing ❑
Or Doors Q7
Accessory Bldg. ❑ Demolition❑ New Signs [ J Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: 'Rt 04 x.
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative ❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
sa:If°Nevit!t Ouse=and orad`dition'to"existing'.liou"sing com'pletb'Ahe:foll' wine:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms _
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Mascheck Energy Compliance form attached?
In. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
_�&, 1 J/
�! " f a, Y , as Owner of the subject property
hereby authorize �C c/i /�n to act on
my alf,,in all matters r tive to work auth,: ized by this building permit application.
Signature of Owner Date _
1 E
as Owner/Authorized Agent
hereby declare that the tatements and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
,)"A L� 6 . +;J fi
Print Name
Signature of Owner/ gent Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parkina Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW 1% 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 #
B. 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:
C. Do any signs exist on the property? YES NO _
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
of Northampton 5 atu #P
tu, t1 V l5 i ding Department
2 Main Street Se er%Sepc ab ;` ,
{
yy( Room 100 Wa erWeil ' v iii
1 JUN 2 2002 N rtha pton, MA 01060 Turo Sets oSt c bra . a s
-58 -1240 Fax 413-587-1272 PI Site�Pans f � ,¢
DEP10f BU'l DING INSPECT104S Other�Specify�����
Twm,EQN.M� 01060
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to;be completed by office
Map Lot Unit `
Zone= �Z• Overlay�D�strict
Elm St. District CB'District
SECTION 2 -?PROPERTY OWNERSHIP/AUTHORIZED AGENT
4ae,( r f Record:
ng Current Ma i,J{ng
Telephone
Sig a ure _
2.2 Authorized Agent:
Name Print) Current Mailing Address: w '
It �f..�-•a= �-� Y ��lL�ai��
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars)to be Official Use Only
completed by ermit appiic ant
1. Building C'i (a) Building Permit Fee
r�'`
2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 + 2 + 3 + 4 + 5) Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
tl TM BP-2002-1140
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot:-001
Permit: B u i I d i nib
Category: windows replaced BUILDING PERMIT
Permit# BP-2002-1140
Project# JS-2002-1835
Est.Cost: $2800.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: EDWARD QUINN 055499
Lot Size s(sq. ft.): 10018.80 Owner: LEARY RUSSELL J&
Zoning.URA Applicant: EDWARD QUINN
AT. 12 WINCHESTER TERR
Applicant Address: Phone: Insurance:
126 EAST ST (413) 527-9408
EASTHAMPTONMA01027 ISSUED ON:6121102 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
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 6/21/02 0:00:00 115 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo