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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 1 q Additions
a
APPLICATION FOR PERMIT TO ALTER Repair
Garage
I. Location �'`� J Lot No.
2. Owner's name �� °:� r c' Address
3. Builder's name �-L '✓ 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
14. Estimated cost
The undersigned certifies that the above statements are we to the best of his, her
know le"d/,be lief.
Signature of responsible app,icant
Remarks
s�o .-
9 d �' �asanchnsctta
AUG 1 8 QQ8 _
m DZrP TMEN"T OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
OUT OF 81,
,�OR ' n,` �bt.:;0 Northampton, Mass. 01060 y
WORKER'S CONMENSATION INSURANCE A+MAVIT
1,
(licensecJpermittee)
with a principal place of business/residence av
(phone#)
(stTeet/ci tylstatrJzi p)
do hereby certify, 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 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) (Insurance CompauylPoLiq Number) (Expiration Date)
(Name of Contractor) (Insurance Compaliy/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance ComI3. y/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(auarh additieeid seect if noccsLvy to iocWc iafonnstion pertaining to all ooatmdors)
( 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 awaro thst whilo homeoKncrz wtio employ persons to do mxirit +•�0=3tudion or mpa-ir worst on a dwelling of
not more than throo units in which the bomoowocr reat6=a oo the$rouads appurtenant thereto arc not gully coasidarcd to be
employers under the worker's oompa_ns4on Act(GL152,ss 1(5)),z.1v -tion by a homeowner for a licrase ee permit may evidmce the
legal elatua of ass employer under tho Woricods Comprmaiio .Ad_
I underaiand that x oopy of this cta=ncnt nuy be forv4vxded to tho Deputncaa of lndushial Ac6 deab C ffioo°f 4-Ur'n-for the
coverage verification and that failure to secure covcrngo under section 25 A of MOL 152 can Icad to tbd imposition of criminal penalties
oomisting of a f ne of up to S1,500-00 aadtoc impriuonmcat of up to one ycsr and civil pc=1tia in the form of a Step W oric Order and a
fine of 5100.00 a day against me.
i Foe dcpsrtntental use onty
Permit Number
Map# Lot#
siguahire ofLicenseelPermittce
g $ (riff of Norfjumpton
- A'• J�saeaC11usrtts
I EPARTMENT OF BUILDING INSPECTIONS
AUG
INSPE T 212 Main Street ' Municipal Building '
OF SLI Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
L (Please Print)
DATE: �� ^� 0
JOB LOCATION: "-� A r
(Map) (Parcel ) ( Subdivision)
HOMEOWNER• 0 1_c
(Name & Ad ress )
c��it Elf- �l .
(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 . c
HOMEOWNER SIGNATURE —) <4
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: A,/ IA
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This colaam to ba filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&Paved Parking)
# 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 know-ledge.
DATE: � ' � �� � � APPLICANT's SIGNATU ��
NOTE: Issuanoe of a zoning permit does not relieve an a `
zoning requirements and obtain all required PPlioano burden al comply with) .ill
q permits from the Board of Health. Conservation
Commission, Department of Publio Works and other applioabla permit granting authorities.
FILE #
V Ali 1 81996 ' '
Fi 1 e No.
DEPT OF BUI ,
NORTNr�
2',02YING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: 90 L')12 FS �� Telephone:
2. Owner of Property:
Address: Telephone:
3. Status of Applicant: _Owner Contract Purchaser Lessee
Other j(explain):
4. Job Location: 'a"E'Tx 0, r
C /''
Parcel Id: Zoning Map# � Parcel# District(s):
(TO BE FILLED IN BY THE B ILDING DEPARTMENT)
S. Existing Use of Structure/Property 9C-J 1 C-
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):t�l
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 PermitA/ariance/Finding ever been issued for/on the site?
NO z DON'T KNOtN 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)
Department: Reference No: BP-.1.99.9-020.0......
Building, Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No-
Vinyl siding
.......................................................................... REC-1.999-000398
PaidBy: ......................................
Charles Dole Paid in Full On:
......... ......................................................................... Tue Aug 18,1998
ceived By: ......................................
Check No:
Linda .Lapointe
894
......................................
DEPARTMENT'S COPY Amount: $20.00
............ ..............
1)1�,PARTMENTFILE COPY 908 BURTS PIT 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:
18 Aug, 1998 BP-1999-0200 $20.00
GIS Man Block: Lot: Address: Zoning: Use Group: Lot Size:
7263 36 184 001 908 BURTS PIT RD SR 258746.4
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-1999-0338 vinyl siding $2,860.00
Description of Work:
INSTALL VINYL SIDING
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: