25A-132 (3) •
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building
Northampton, MA 01060
Applicant Information `
Name—��L�a[ — �_ ----------------
Location � L a L V
city 7`10-L
--- - -----------------
�I am a homeowner performing all work myself
D I am a sole proprietor and have no one working in any capacity
❑ I am an employer providing workers'compensation for my employees working on thisjob.
Company Name ------------------- --
Address
City-- --------------- Phone #--------
Insurance Co.-------_----_—Policy#------ ---
Company Name
Address
City Phone#
Insurance Co. Policy#
i
Failure to secure coverage as required under Section 25 A of IYIGL 152 can lead to the imposition of criminal
penalties of a fine up to$1500.00andfor one years'imprisonment as well as civil penalties in the form of a STOP
WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement maybe
forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify under the pairs and penalties of perjury that the information provided above is true and correct.
Signature Date
Date S�o20 j�
Print Name ��r/ / `
�t C �� rr7`t I� Phone# S rf `7 ""'
Official Use Onty Do not write in this area to be completed by city or town official
City or Town PermiVLicenser ❑ 13mlU-cDept
D Lrensin�Bond
Check if med
imiate response is required
Contact Person 0 k> ,�
Phone#
E] Heahh Dept.
M
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� ^� Zoning
//
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Jk` Y-� / Alterations
NORTHAMPTON, MASS. / � 19 Additions
' APPLICATION FOR PERMIT TO ALTER Repair
Garage
I. Location 7) l e
Lot No.
2. Owner's name t ckCLISCU WML Address —S Qa- t )q U C
3. Builder's name a h A y e Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
b. New Porches � dzl
7. Is existing building to be de lished?
8. Repair after the fire
9. Garage No.of cars Size
I0. 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 true to the best of t
knowledge and belief.
Signature of responsible app,icant
Remarks
OR� rpTO t 1 ON,
*„
8 X as 5 MCI)118 r H Is
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01060 "
HOMEOWNER LICENSE EXEMPTION
/ ( Please Print )
DATE• �(
JOB LOCATION: J `
(Map) Parcel ) ( Subdivision)
HOMEOWNER- leu U e
-Name & Address) X ��
(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 buildipq
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.
HOMEOWNER SIGNATURE
BUILDING PEfZMIT _�s
1 o. 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.
Thin column to be filled in
by the Building Department
Required
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 parkingi
# of -Parking Spaces
ht fof Loading Docks
Fill:
-(vol-ume-& location)
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
DATE: / APPLICANT's SIGNATURE
NOTE: tss anoe o a zoning permit does not relieve an applicants urden to 0o ply wit4 4111
zoning ulrema' is and obtain all required permits from the Board of Health. Conservation
Commission. Department of Pubno Works and other applloable permit granting authorities.
FILE #
r
JUN 31988
File No�' �c-; `
DEPT OF BURDIN6 INIFECTIOiti; ,
NORTIJAM MA 01 .NG PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: A2 L'I dF'
Address: 7 Ale Telephone: . 811 &_L2>-7
2. Owner of Prope y: �d
Address: Sc. �^^ e _Telephone:_
3. Status of Applicant: ./Owner Contract Purchaser Lessee
Other(explain):
r'�`
4. Job Location: b 61-e—
Parcel Id: Zoning Map# Parcel# 13 , `District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5, Existing Use of Structure/Property
6. Deschpti o of Propo d Use/Work/Proje Occupation(U e additional sheets if necessary):
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.
S. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNO:N 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 C/ 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)
' y
File#BP-1999-1028
APPLICANT/CONTACT PERSON SMITH RICHARD F&ANNE D
ADDRESS/PHONE 39 DAY AVE 584-8227
PROPERTY LOCATION 39 DAY AVE
MAP 25A PARCEL 132 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled ut
Fee Paid /
Typeof Construction: REPLACE DECK&STRINGER ON FRONT PORCH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
I T 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 Commissi
Signature of Builvilrofficial 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.
f r
39 DAY AVE BP-1999-1028
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25A- 132 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-1999-1028
Project# JS-1999-1744
Est.Cost:$100.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group:
Lot Size(sa.ft.): 23565.96 Owner: SMITH RICHARD F &ANNE D
Zoning.URB Applicant:_
ATL., 39 DAY AVE
Applicant Address: Phone: Insurance:
ISSUED ON.61911999 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPLACE DECK & STRINGER ON FRONT PORCH
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 6/9/1999 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo