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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 1 Lot No.
(/2: Owners name fi� /�- H L R's Address S F
3. Builder's name Address
ass.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 No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof
13. Si house
4 Estimated cosL-
t U a
7-v7-A", 7i� 0 �) The undersigned certifies that the above statements are we to the best of his
/i' knowledge and l•
Signature of responsible app.icant
Remarks
CITY OF NORTE AMPTON
i 212 N'IAIN STREET-MUNICIPAL BUILDING
o ; a
NORTHAMPTON,MASSACHUSETTS 01060
-BUILDING PERMIT FEES
DEMOLITION S10.00-ACCESSORY STRUCTURE
$35.00 -PRINCIPAL BUILDING
NEW CONSTRUCTION,
S.40 per square foot for the 1" floor
S.20" "2"4 floor
S.1011 " '/I floors, attic,basement, garage
INTERIOR STRUCTURAL ALTEIZ4T'IONS IN ALL USE GROUPS:
S5.00 Per Thousand dollars of estimated cost or fraction
t minimum fee of Fifty Dollars(SSO).
«IOODBURNING STOVES -S25.00
NEW ACCESSORY STRUCTURES , one hundred twenty(120) square feet and over.
S.10 per square foot with a minimum fee of Twenty-five
Dollars (S25.00)
NEW ACCESSORY STRUChURES, underone Hundred and twenty(120) square fec,:
525.00 per inspection
SWTMN'[TNG POOLS 525.00 FOR ABOVE GROUND
S50.00 FOR INGROUND
SIGNS AND AWNLNGS 530.00
Decks 550.00
REPLACEMENT WINDOWS S25.00
SIDING AND ROOFING- residential
per structure S25.00
Tents 525.00
ZONING REQUEST FORMS 510.00
REPLACEMENT OF LOST
BUILDING PERMIT 525.00
CERTIFICATES OF ANNUAL INSPECTION 575.00 MINIMUM
PERMITS REQUIRING ONLY ONE(1)INSPECTION WILL BE A MINIMUM OF 525.00 ALL
OTTERS WILL HAVE A 550.00 MINIMUM. PERMIT FEES SHALL BE MADE OUT TOT 11E
OF NORTHAMPTON AND SUBMITTED WITH THE COMPLETED PERMIT APPLICATION TO
THE OFFICE RK STARTED OUT PE CT
UBLE NORMAL FEE.
CHECK OR MONEY ORDER ONLY PAYABLE TO THE CITY OF NORTHAMPTON
DEPARTMENT OF BUILDING INSPECTIONS
413-587-1240......Pax 413-587-1272
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DEPARTMENT OF BUILDI)\G INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060 '
HOI•fEOWNER LICENSE EXEMPTION
A E: C_P / 4 ( Please Print)
y
JOB LOCATION:
(map) ( Parcel ) ( Subdivision )
iOMEOWNER:
(Name & 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 residers 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 -per-son who
constructs more than *one home in a two-year . peelod shalt not be
considered a -homeowner. - Such "homeowner" shall submit to &lie i uilding
Official, on a form acceptable to - the Building -Official, Oiat' he/'she
shall. be responsible for all such work performed under: the' bui=lding
permit'.
As acting Construction Supervisor your presence on tfie: jyob site
will be required from time to time, during and upon coiripletibn' 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 L al Zoning Laws , and State of Massachusetts
General Laws Annotated
� FLO_ �
� MEOFl)`IER SIGNATURE
BUILDING. PEkKT
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$ d �iassacltnsctta
DEPARTMENT OF BUILDWG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(licenscdpermittee)
with a principal place of business/residence at:
(\J
a S /V pp, (phone#)
(/ (street/city/staldzip)
do hereby certify, under the pains and penalties of pet ury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(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:
1 / D--e /f�' to L,z/6 kt
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date)
(Name of Contractor) (Insanance Company/Policy Number) (Expiration Date)
(anach addidcoal*bed ifneoesssry to include=fmmsuon pat nnag to all cordcactors)
( ) 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 tbat whilo hoa xwvnem who employ persons to do umaAc we,consuw oaor repair work on a dwelling of
not mote than throe units is which the bomeowner resides«on the grounds Wxtertara tbardo are not geaaally considered to be
employ+aa under the vwdoa'a oampeasation Act(GL152,ss 1(5)),application by a homeowner for a liaise a permit may evidence tho
legal lotus ofanemployac under the Wodwes Convocution AcL
I understand that a copy of this mt®eat may be faawudad to the Dopartmcat of Lxhatrial Accidm&015oe of Imm-we for the
oovaage vaT=dion and that failure to town covmv i section 25A of MOL 152 can lead to the impo (u of aiminal peaaliics
ooquAms of a$ne of up to 11,500.00 and/or iarpr6oumcnt of up to one year and civD pea es in the form of a Stop Words Order and a
fmo of 3100.00 a day agaiva ma
For depertme W uao ooty
Permit Number
law Map# Lot#
Signature of Licensee/Peramittee
t
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 —?== to be t"i.11ed in
by the DUIM4ag Depar nt
Required I
Existing Proposed By Zoning
Lot e
F ontage
etbacks
- 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:
{volume -& .location)
13 . Certification: I hereby certify that the information contained herein
is true and accurat o the best of my knowledge.
CV, D E: APP CANTs SIGNATURE
TL. Issuanoa of a zo ng p mit does not relieve an applioant's burden to oompty wltt) all
zoning requirements unk P min all required permits from the Board of Health. Co6servation
Commission. Department of Pubiio works and other applionble permit granting authorities.
FILE if
Fi1e No.
ZONING PERMIT APPLICATION (§10 . 2
PLEASE TYPE OR PRINT
A ,TALL INFORMATION
Name of Applicant: ��`/L �� /V`
i / c445`__
Address: Telephone:
Owner of Property:
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
Job Location: 12S
i
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property U I 0
Description of Proposed Us or roject/Occupation: (Use additional sheets if necessary):
jr7w r,Ai
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 PermitA/ariance/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� 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)
125 NORTH ST BP-2000-0599
GIs#: COMMONWEALTH OF MASSACHUSETTS
j :Block:25C- 173 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Cate o :woodstove BUILDING PERMIT
Permit# BP-2000-0599
Project# JS-2000-1071
Est.Cost:$2000.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO
Const.Class: Contractor: License:
Use Group:
Lot Size(sg.ft.): 6098.40 Owner: EHLERS MICHAEL T
Zoning URC Applicant:
AT: 125 NORTH ST
Applicant Address: Phone: Insurance:
ISSUED ON.12116199 0:00:00'
TO PERFORM THE FOLLOWING WORK:INSTALL WOO DSTOVE
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 12/16/99 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patitlo
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125 NORTH ST BP-2000-0599
61s#: COMMONWEALTH OF MASSACHUSETTS
1<:25C- 173 CITY OF NORTHAMPTON
Lot:-aoi
Permit: Building
Categpry_woodstove BUILDING PERMIT
Permit# BP-2000-0599
Project# JS-2000-1071
Est.Cost:$2000.00
Fee:$25.0U PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License.
Use Grouo:
1,ptt skt s�.ft.): 6098.40 Owner: EHLERS MICHAEL T
Zoni g:URC App ` ant:
AT: 125-NORTH ST
AnplicantAddress: Phone: Insurances
ISSUED CON:12116199 0:00:00
TO PERFORM THE FOLLO NG WO1tk INSTALL WOODSTOVE
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 FireplacetChimuey:
Rough: Ql: Insulation:
Final: Smoke:. Final:. (�� �'a.-��''ob✓��+
THIS PERMIT MAY BE REVOKED BY THE CITY JQF NORTHAMPTON UPON VIOL TION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount•
Building 12/16/99 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo