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Zoning
Miscellaneous Additions, Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
Location 0 D L i Y��v � t) Lot No.
/Owner's name Ade(r-is l e: R I�t' t ;v `Xddress a Q L)Y-1C•o .4."
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
Alteration !L i jrG-e.-,- c.c�L �w�s tv,✓ � .� ��t%1.� r, ;'u ��:,� r az t ��, /�
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
/. Estimated cost:-
� vd�
J
The undersigned certifies that the above statements are true to the best of his, he:
,,-1�owledge and belief.
Z//--
Signature ojresponsible app:icam
Remarks
$ X911! (V1g J
99 xsaxcllnaetla
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01060
r
HOMEOWNER LICENSE EXEMPTION
� ( Please Print)
DATE; ��, ��
JOB LOCATION:
r Map ( Parcel) ( Subdivision)
HOMEOWNER: 02a L r-,c_o a � 4
(Nam
Address )
- (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.
LHOMPOWNER SIGNATURE
f
BUILDING PEkMIT #
,r.
T7 7U_ if Nlarf haillpta Y M z
� Ir i. � �
n' ` e 2 199gDEP, I s MENT OP BUILDING INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building '>e
1„ S.♦
Northampton, MA 01060
=AppIricanty
Name Lm a homeowner performing all work myself
m a sole proprietor and have no one working in any capacity
❑ I am an employer providing workers'compensation for my employees working on this job.
Company Name ------------------- --
Address
City-- --------------- Ph one#--------
Insurance Co.-----------_—Policy#------ --_
Company Name
Address
City Phone#
Insurance Co. Policy#
Failure to secure coverage as required under Section 25 A of MGL 152 can lead to the imposition of criminal
penalties of a fine up to$1500.00andlor 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 DA for coverage verification.
do hereby certify under the pairs and penalties of perjury that the information provided above is true and correct.
i.
Si Date ;``I- f
Print Name
lN!�/C/c' t . fd�i�'1 Phone 5' S. 17 C,7
Official Use Only Do not write in this area to be completed by city or town official
City or Town PermitlLicenser- ❑ l3uUrtcDept
E]LiexuizK Bond
Check if irnmediate response is required
Contact Person Pho ❑kk
Phone�
❑ Heakh Dept.
d
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 coluam to be filled in
?t by the Building Department
r-
t — I 1 , _
I ; J
I
Existing
Proposed
rKuquil au I
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-time--& location)
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
DATE.; c3/ PLICAIT's SIGNATUREit'7�
1 s fssuanoe of a zoni oes not relieve a4'� appiioants burden to oomply wltir all
zoning requirements and obt required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
21999 / �a
File No.
ING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
Name of Applicant: AvA e It idt
vim' —Telephone: n J
Address: �� L t>'�'b �ti ,� P "T 6/ 17 -
Owner of Property: c) P �r) /'J
Address: ;-a L �,, I.J Y k,-e_ Telephone:
3. Status of Applicant: Owner _Contract Purchaser Lessee
Other(explain):
Job Location:Parcel Id:Id: Zoning Map# Parcel# 1)6 District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5, Existing Use of StructurelProperty
6. Description of Proposed Use or roject/Occupation: (Use additional sheets if necessary):
1 l2- �inT,
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 V 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)
File#BP-1999-1026
APPLICANT/CONTACT PERSON PETRIN ADELAIDE P
ADDRESS/PHONE 22 LINCOLN AVE 585-9949
PROPERTY LOCATION 22 LINCOLN AVE
MAP 25C PARCEL 088 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildiny,Permit Filled out
Fee Paid
T_ypeof Construction: REMODEL KITCHEN&INTERIOR WINDOW
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License
3 sets of Plans/Plot Plan
THE F LOWING 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 Comm' ' n
Signature of bViTding Official 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.
22 LINCOLN AVE BP-1999-1026
GIs#: COMMONWEALTH OF MASSACHUSETTS
M Block:25C-088 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-1999-1026
Project# JS-1999-1743
Est. Cost: $6000.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group:
Lot Size(sq.ft.): 6621.12 Owner: PETRIN ADELAIDE P
Zoning:URB Applicant:_
AT: 22 LINCOLN AVE
Applicant Address: Phone: Insurance:
ISSUED ON.•6/9/1999 o:oo:oo
TO PERFORM THE FOLLOWING WORK.-REMODEL KITCHEN & INTERIOR WINDOW
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