25C-126 (3) AO%g
CITY OF NORTHAMPTON
ZONING PERMIT APPLICATION Map No.,y, L Lot /,2
i 1983
Zoning Ordinance Section 10.2 A�ei 4 i No. � Plan File
DEPT. F BUILOM
Owner �� rSTiLvT`irlLS No
Address cz .<<h cr�L,�r L9�r>` Address
Telephone 5_k'b-GPVk Telephone
This section is to be filled out in accordance with the "Table of Dimensional and Density Regulations:
(Z.O. ARTICLE VI)
Zoning Use Lot Front Depth Setbacks Max. Bld. Min. Op.
District Area Width Front I Side Rear Cover Space
Past Existing
Present Proposed % %
Mark the appropriate box to indicate the use of the parcel:
❑ Non-Conforming Lot and/or Structure. Specify
;'Residential ❑Single Family Unit XMulti-Family
❑ Duplex ❑ Other
❑ Business
❑ Individual
❑ Institutional
El Subdivision ❑ Regular El P.U.D.
❑ Cluster Other
"A roval-Not-Re uired"-Starr :
❑ Subdivision with pp q p
❑ Planning Board Approval:
❑ Zoning Board Approval (Special Permit 10.9: Variance)
❑ City Council (Special Exception S. 10.10)
Watershed Protection District Overlay: (Z.O. Sect. XIV) ❑ Yes ❑ No
Parking Space Requirements: (Z.O. Sect. 8.1) Required Proposed
Loading Space Requirements: (Z.O. Sect. 8.2) Required Proposed
Signs: (Z.O. Art. VII) ❑ Yes ❑ No
Environmental Performance Standards: (Z.O. Art. XI 1) ❑ Yes ❑ No
Plot Plan DirYes ❑ No Site Plan ❑ Yes ❑ No
(S. 10.2) (S. 10.2 and 10.11
Waiver Granted: T Date ❑
This section for OFFICIAL use only:
❑ Approval as presented:
❑ Modifications necessary for approval:
❑ Return: (More information needed)
❑ Denial: Reasons:
ignature f Applicant ate Signature of Admin. Officer Date
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. Additions
i
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location / �c� � i Lot No.
2. Owner's name \1 c,.� Address S
3. Builder's name n. V)>r— � ,�j�� Address -.a- C° �-+ -� ate_
Mass.Construction Supervisor's License No. -/a o — 9 9 Expiration Date, F�
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 true to the best of his, her
knowledge and belief.
r r�-
Sign Cr.! of responsible app,icanl
Remarks
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:
II _ ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
Thin cols to be
by the BniZding Department
Required
Existing Proposed By Zoning
_ot size
rontage
Setbacks - frnnt
- side L: R: L: R:
- rear
3uilding height
31dg Square footage
/oOpen Space:
Lot area minus bldg
&paved parking)
r of Parking spaces
u of Loading Docks
(volume & location)
3 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge .
)ATE: �� ��' APPLICANT's SIGNATURE��
VOTE: lssunnoe of a zoning permit does not relieve nn app loants rden to oomply with all
coning requirements and obtain nil required permits from the Bo of Health, Conservation
;ommission, 17epartment of Publio Worics and other npplionbie permit granting authorities.
FILE if
Fi 1 e No DE�"T t;F BU ;,'r,
t� iVURTI�A,;,r fip�( ts�+ICP�iaG idS
n
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:_ V y o
Address: C}vt �/� -- Telephone: c2
2. XOwner of Property:
Address: 3' Telephone: I,—,j;; 6 �-
3. Status of Applicant: Owner _Contract Purchaser Lessee
Other(explain):
4. Street Address:
Parcel Id: Zoning Map# 1-5 Parcel# �c District(s): �/`V
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
J Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
I. 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.
3 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#
3 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)
FILE it f ,
APPLICANT/CONTACT PERSON-
ADDRESS/PHONE: ��
PROPERTY LOCATION:
MAP oZ'�"� PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
3 QPtvnfP1.qny /Pint Inn
C
THE FOLLOWING 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-Bd of Health Well Water Potability-Bd Health
Permit from n rvation Com 's on
"7/ --- - 8/8
Signature ofluilding Inspect Date
NOTE:Issuance of a zoning permit does not relieve an applicants burden to oomply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
City of Northampton REQUIRED INSPECTIONS
�
BUILDING DEPARTMENT 1. Footings and Walls
2. Structural Components in Place*
3. Complete Building*
No. 668 Office of the Building Inspector
Zoning Form No. 960103 Date 8/8/95 Fee$20 Check#1371
Page, 25C Parcel 126 , Zone uRB Section 127 ❑ Yes ❑ No
BUI]LDINGPERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Larry Paquette before Building Inspections
has permission to install replacement windows Inspection on Site—Foundations
situated on 18 Elizabeth St. - Paul Struthera Inspection of Plumbing—Rough
provided that the person accepting this permit shall in every respect Inspection of Plumbing—Finish
conform to the terms of the application on file in this office, and to the Gas Inspection
provisions of the Statutes and the Ordinances relating to the Construction, Inspection of Wiring—Rough
Maintenance and Inspection of Buildings in the City of Northampton.
Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring—Finish
of this permit.Expires six months from date of issuance,if not started. Building Inspection—Rough
Note:A certificate of occupancy will be issued by this office upon return Insulation Inspection
of this card signed by the Plumbing,Wiring and Building Inspectors.
Building Inspection—Finish
** Install per Manufacturer's information: windows, vinyl siding,roofs Smoke Detectors (Fire Department)
and woodstoves
Other
THIS CARD MUST BE DISPLAYED IN A CON$PJCVOUS PLACE ON TK P MISES
Certificate of Occupancy
Building Inspector
CHARLES T LAVECK
HOME IMPROVEMENT
413-527-5604
DEPOSIT UPON ACCEPTANCE OF CONTRACT $1,000.00
PARTIAL PAYMENT $29000.00
BALANCE DUE UPON COMPLETION $4,700.00
I AGREE TO TERMS AND CONDITIONS WITH ABO I1'E
SPECIFICA TION,AND A GREE WITH PA YMENT SCLIED ULE,AND
WORK MA Y BE STARTED AT ANY TIME
PA UL
STR UTHERS .J DATE
] CHARLES T LA DECK HOME IMPROVEMENTS AGREE TO
FURNISH ALL MATERIALS AND LABOR FOR THE ABOVE
SPECIFICATIONS,AND AGREE TH fa T ANY EXTRAS WILL BE IN
WRITING PRIOR TO STAR TTN�;7
CHARLES T LA NECK Wednesday,
June 27, 2001
ANY QUESTIONS PLEASE CALL
VINYL SIDING COMES WITH MANUFACTURER LIFETIME
GUARANTEE
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
( WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(Iicenstelpermittee)
with a principal place of business/residence at:
✓ f�//> S l ` �7�/ (phone#)
(streeticity/statrlap)
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 worlang on this job:
(Insurance Company) (Policy Number) _ (Expiration Date)
( j I am a sole proprietor, general contractor er homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Poticy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compaay/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additioml street ifnxcnsry to inclrsde iafacrostion pertniuing to ail coafradora)
(k) 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 hom0owness who emploY Pam to do maiutexiaace constmCion or rtpair woril on a dwelling of
not more than three units in which the homoowncr rides or oo the g vuads appurtenant thereto an oot geo rally oowakred to be
employes under the warka's oompcus4on Act(GL152,m 1(5)�application by a homeowner for a kcase or permit may evidence the
legal etntur of an ornployeC under the Worker's Compemafion AAA-
I uaderataad that a oopy of this rutcmcat may be forwarded to tho Dgwt,x of In&u &I Ac6dm&Offloo of I2%n for the
coverage verification and that failure to&Darn oovetngo under soctioa 25A of MGL 152 can lead to tba impositioa of criminal penalties
Of a fine of S4500-00 and/or finNisonroccl of tip to one year and civil pcmltia in the form of a Stop Work Order and a
firm of S 100.00 a igainsl roc. .
For woo o°ty
� Permit Number
I,dapjt Lot#
� ,. 1»ture of Licensecepermi e
SECT bbl 8 �ONSTRU,CT10 SERVICES
F,.
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
.e ,Ih „m rr�Ver�if�n�:� �rt � ," � i Not Applicable ❑
dl"pany Name Registration Number
srf z'= D.5
Address Expiration Date
Telephone
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G L. c. 152, §_25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with is application. Failure to provide this affid
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... ❑ No...... ❑
,ame
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)famili
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner act
as supervisor. CMR 780, Sixth Edition Section 108.3.5.1.
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,
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
S CT IONfS 6 eCRIP,,IOiCOF,.P�ROPOSED)W RRIOi' cgl r II.La Olicab'le
3'.-: ,.,k .s>.M :'. ,N3..•u4i'Pr9 a,.,tl6� •-,.H.,fF313,s s� r.,sv ,.,-a _2'.4i.9uq,.gtR�,:r,N`3tl3ANsF�l3 .'..fSyiYan- .v,�;,'v, .i..hr, t � ,tiE 3„n,�:.
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding Other [ ]
Brief Description of Proposed Work: (N� �_WC
Alteration of existing bedroom Yes_ No Adding new bedroom Yes _ No
Attached Narrative❑ Renovating unfinished basement _Yes No
Plans Attached Roll ❑ - Sheet❑
"F1f Nd-W3 ou$e,"h-dtdKWdit an to existing riO srng; cortiple#ti the.°fol"Iow�ng
a. Use of building : One Family__LK_ Two Family _Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstove Number of each
g. Energy Conservation Compliance. Mascheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft, of wetlands? Yes No. Is construction within 100 yr. floodplain Yes
j. Depth of basement or cellar floor below finished grade V_
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a .OWNER AUTHORIZATION -T,O BE COMPLETED WHEN
OWNERS, .OENT,''ORCONTRACTOR;AP01.111 Fb'9UILDIN6PERMIT
1. as Owner of the subject prope.
hereby authorize to a,
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
l,1 gbydecl�are as Owner/Authorized Agert
h that the statements and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Si ,u r the pa' aalties of perjury.
e
Signature of Owner/Agent Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
volume&Location _�.
A. 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 #
B. 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:
C. Do any signs exist on the property? YES NO ?L .
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
City of Northampton
Building Department
212 Main Street
Room 100 t
Northampton, MA 01060 ets;
phone 413-587-1240 Fax 413-587.1272 0 % P#
Q e Spo - a
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION l -SITE INFORMATION
This section to be completed by offrce
1.1 Property Address:
Map Lot ¢^ #
XV
777 v Zone Overlay Districtx "
A-1
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS e2 O
Item - Estimated Cost(Dollars)to be Official Use Only
oev //t completed by ermit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from! 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) 700 Check Number
This Section For Official Use Only
Building Permit Number: Da to Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
LB° .IZABETHST BP-2002-0692
GIS#: COMMONWEALTH OF MASSACHUSETTS
.Block: 25C- 126 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: vinyl siding BUILDING PERMIT
Permit# BP-2002.0692
Project# JS-2002.1107
Est. Cost: $7700.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: CHARLES LAVECK 121419
Lot Size(sq. ft.): 5183.64 Owner: STRUTHERS PAUL J&D DUNPHY&
Zoning:URB Applicant: CHARLES LAVECK
AT. 16-18 ELIZABETH ST
Applicant Address: Phone: Insurance:
25 DAVIS ST (413) 527-5604
EASTHAMPTONMA01027 ISSUED ON:214102 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL VINYL SIDING
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
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 2/4/02 0:00:00 2440 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo