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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location 2-7 e)/ l7) yJ 9 E sf r / V U/'�T�{i�4Y1 J��AJ Lot No.
2. Owner's name /yC�/i?M,4A-) Uty Address _66u77-1 1n/i/ AVL'
3. Builder's name Address �ou 7-W
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
6. New Porch
7. Is existing building to be demolished? &,4R/)
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 cosL-
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
Signature of ponsi app�icant
Remarks Q C9�
ir
i�o�gTO� i
.. .... (rz#lr of 'Narf4ulllptall ;
J�p ' �A98A[I)IIS ttIS T
DEPARTMENT OF BUILDING INSPECTIONS
DEPT pfBrs
INSPECTO hf�Ot t"°' 212 Main Street ' Municipal Building .'
M
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE• I �a
JOB LOCATION:
(Map) (Parcel) ( Subdivision)
HOMEOWNER: o2 !: i�%L� d U l
_(Nam//dress ) y15?�V
(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
hermit.
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 PERMIT #
� 17 �99�
JUL z
�JU- �assachttsrtts
m DEPT Of Et!. `1 DEPARTMENT OF BUILDrNG INSPECTIONS
NMI Main Street e Municipal Building
Northampton, Mass. 01060
WOR CER'S COMPENSATION INSURANCE Ar,MAVIT
(licensee/permitiee}
with a principal place of business/residence at:
02 �/D6E v`7- 9.10 771, 11 76 (Phone#)
(Stmet/city/StarrJzi p)
do hereby certify, under the pains and penalties of perjury, that:
O I am an employer providing the following workers compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Daze)
O 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) Unsi=cc Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional shod if noectsary to include information pertaining to all«radon)
( ) 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 while homccwvcra who employ pc:r n to do main�coastrucuoaor repair work on a dwelling of
not morn than three units in which the homoowncr reidcs or oa the grounds aplxutcnard lhercto arc not gwcrnlly 000sidcred to be
employers under the worker's oompcmatioa Act(GL152,=1(5)),appUcation by a homeowner for a licmic or permit may evidence the
legal oa of an employer under the Woriroet Compc�on Ad
I undcrstomd that a copy of this ctatemmt may be forwarded to the Dtpnrtnxo2 of Ind trial Amdta&OMOO of Irrruranoe f or the
eoverne vcri$eaiion and that fail=to secure covenrgo under section 25 A of MGL 152 can lead to tba imposition of criminal penalties
ooausung of a fine'of up to S1,500.00 and/or imprison of up to one year and civil pcnxWC3 in the form of a Stop Work Order and a
find of S 100.00 a day against tee.
For dgmtncoal use only
Permit Number
Map# Lot#
Si of Li ermi Late
Rim_...
10. Do any signs exist on the property? YES NO_ y
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 DEN'-TED DUE TO
LACK OF INFORMATION.
.�'� Thin coItmm to be Pilled in
by the Banding 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)
Parking spaces
# of Loading Docks
Fill:
4vol-time--& location)
13 , Certification: I hereby certify that the information contained herein
4j is true and accurate to the best of my know edge.
ATE: 2— I J g --APPLICANT's SIGNATURE
NOTE: Issuanoe of a Zoning permit does not relieve an applicant's urdea to comply with ,401':-
zoning requirements and obtain all required permits from the Board of Health,, Cohoe"ation.
Commission, Department of Publio Works and other applionble permit giranting puthorities: -
FILE #
S
DEPT Of_$11
File No.
s
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: d�i?'1l�� d u/V G
Address:,2 E/,�)a !�-7 %,57- N �t6�J Telephone:
2. Owner of Property: 5i6, d F
Address: -- MI/ J SCI I/�� Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): y
4. Job Location: �� .C") 3 i�1J 0 k
Parcel Id: Zoning Map# Parcel# 63 District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMEN
5. Existing Use of Structure/Property !'1'l/&'
6. Des tlroposed Use/Work/Project/Occupation: (Use 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.
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__x_ 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)
15 U.,15 U t'1 rr FILE
L,
F �- PZIC /CONTACT PERSON: U-� 4r"�
_ADDRESSAMONE:
PROPERTY LOCATION- JZ ,
MAP__ PARCEL: /_ 70NE ►� ,._..
THIS SECTION FOR-0FFICIAL USE ONLY:
PERI UT APPLICATION +CHECKLIST
ENCLOSED REQUIRED DATE
7ONTNG FORM FYT T,FT) ()ITT
Fee Pnid
Rnilrlinv Permitv�
-Fee Pgifi
ArrPStnry StructurP
-i Sets of Plans / Plot Plan
THE OLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
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: § NN/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-Bd of Health Well Water Potability-Bd Health
Per om C servatio mission ,
Signature o Building Inspector Date
NOTE:laauanoe of a zoning permit does not relieve an applicant's burden to oompty with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commisslon, Department of Publio Works and other applioable permit granting authorttles.
Department: Reference No: BP-1.999-0090
................................••.
Building,Electrical & Mechanical Permits
Fee Type: Receipt No:
demolition REC-1999-0001,56
.........................................................................................
......................................
Paid By: Paid in Full On:
Norman Young Tue3ul 21,1998
................. .......................................................................
......................................
Received By: Check No:
Linda Lapointe 4397
.........................................................................................
......................................
DEPARTMENT'S COPY Amount: $10.00
...........................
l)E111ARTM11�1'N,,r FILE COPY 270 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: Tracking No.: Fee:
22 Jul, 1998 BP-1999-0090 $10.00
GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size:
4449 25C 063 001 270 BRIDGE ST URB 12893.76
Contractor: License Type: Insurance:
Homeowner as Contractor
Address: License No.: Insurance No.:
Liy_i State: Zip Code: Phone:
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0132 demolition
Description of Work:
DEMO BARN
GeoTIVIS@ 1997 Des Lauriers&Associates,Inc. Signature: