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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. l° Lo 191'5 Additions
APPLICATION FOR PERMIT TO ALTER Repair
l. Locations 1 Lot No.
2. Owner's name Address 3 a-3 2f-
3. c i
3. Builder's name 1 k 5c, 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 � W- S No.of cars Size
10. Method of heating lam)_ c
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost:- C7Z7
The undersigned certifies that ve statements are true to the best of his, her
knowledge an tef.
Signature of responsible app icant
Remarks
m
�~ �� � iJ ii ynR54F{t11t8lt11f '
(5ftLy -of Nor f4ally toll
DAPARTMENT OF BUILDING INSPECTIONS �
INSPECT 2 910 X112 Main Street ' Municipal Building '
Northampton, Mass. 01060
DEPT v
NORTciiil�'hlft MA
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE• ��' 3 o z S c�
JOB LOCATION:
57yp) (Parcel) (Subdivision)
HOMEOWNER: �� c I -�-�
(Name & Address )
(Home Phone) (Work Phone)
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one ( I )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 buildinq
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 Zo g Law and State of Massachusetts
General Laws Annotated.
HOMEOWNER SIGNATURE
BUILDING PERMIT # A
Crib )af �x#I�ttntrii
a � � � l� � ,�7tSEACIi tiStll6
m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
_. Northampton, Mass. 01060
W. OR ER'`S ONTENSAISON INSITMZ NCE +MAV17
(lice"nseelperm i ticc)
%lath a principal place
( of busiaess/residence at:
(phone#)
��� (street/city/statelap)
do hereby certify, under the pains and penalties of pegufy, that:
( ) I am an employer providing the following worker's compensation coverage for my ,
employees wordng on this)ob:
(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:
(T me of Contractor) ((.R L2nC Conn-an-dPol]Cr NLII1CCr) (�tplraLoa Date)
- -(hale of Coutractor) -- (llsa2nc ComeaniPo!ic;titua er) (Expiraion Date)
(Name of Contractor) (lnsu=cn� Comparry/PoLcy Number) (Expi.raaon Date)
(Name of Contactor) (Iasurmcc Comoaz•/Policy Number) (Expiration Dale)
(a(tach a0diticail r;ecf ifneez to ineluc+c iafcfmi:iea pertaining to all 0_-Utran•.o:3)
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 whilo I)O(DC0-Amm At)o cmploy pGcct Dr to do mxiatry.M�COosttUCtioc or TcVair'1vo[SC C'U 1 of
not morn th_n throo units is«-Rich the bamooavcr r=J,=or oa the ucunr's zpptutca:ni tba-do,oot gcocar iiy oomidcl d to be
employcn under tho workers oompassstieo Act(GL152,s 1(5)),apptic.6on by a homeactvrl for a 6-nse a permit may evtdeoce the
legal rUtua of an arnploye'r under the Workces Cone at Aa.
I undcrsiwd thzi a copy of this mtcu cat may bo forsvardod to the Dc-partnxut of Inchutrinl A.ocidrnLa'OfSoo of ln—for th.
covcra vai.ficaiioo and that Ed=to secttre costs-V under soctloa 25A of),10L 152 can 1,-d to tbd imps oa of Criminal pcalwe& ..
ooasisting of a floc'of ttp to S 1,500.00 or bmprjsoe of lip to one year and civil pevxlties io the form of a Stop Work Order and a
fino
o(5100.00 x day appiust mc_ ,
. ' For&P-tw l xf—oa1y.
permit NumbeT
Lot 4". 1
_. &a1h?n ofLtccnscc/Pccmi
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.
Thfs aol== to be filled in
by the BniSdinq Dcpartmant
Required I
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
# of -Parking Spaces
t of Loading Docks
Fill:
{vo1-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DA-WE: APPLICANT's SIGNATURE
NOTE: lasuanoa of a zoning permit does not relieve an applioant's burden to oomply wittX .alt
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission, Department of Publio Works and other applioable permit granting authorities,
FILE #
w r 2 9 t,QW File
°BFI NIORT� ZONING PERMIT APPLICATION (§10 . 2)
.� '`�`PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: c�
Address: 3 (`3 ,� _Telephone: _ a ? s��(- �(/�
2. Owner of Property:
Address: Telephone:
3. Status of Applicant: zlOwner Contract Purchaser Lessee
Other(explain): /
4. Job Location:
Parcel Id: Zoning Map# Parcel# k District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description /o^f�Prorq��l�sed Use/Vllork/Project/ cupation: (Use additional sheets if necessary):
W�L\ S p
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 KNOlN' 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-1999-0456
.......................•...........
Building, Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Woodstove REC-1999-001,206
.P�W�v.......................................................................... ......Pai d':---------------------------
in Full On:
Kenneth Salem Fri Oct 30,1998
.........................................................................................
......................................
Received By: Check No:
Linda Lapointe 333
.........................................................................................
..........................•...•.......
DEPARTMENT'S COPY Amount: $20.00
................. .........
D1 PARTM F.NT FILE COPY 323 BRIDGE ST
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: Trackini!No.: Fee:
30 Oct, 1998 BP-1999-0456 $20.00
GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size:
4325 25A 110 001 323 BRIDGE ST URB 52707.6
Contractor: License Type: Insurance:
Homeowner as Contractor
Address: License No.: Insurance No.:
City: State: Zip Code: Phone:
Proiect No: Category of Work- Const. Class: Cost Estimate:
JS-1999-0401 woodstove $300.00
Description of Work:
INSTALL WOODSTOVE IN GARAGE
GeoTIVISO 1997 Des Lauriers&Associates,Inc. Signature: