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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
` Repair
APPLICATION FOR PERMIT TO ALTER
s Garage
"�l. Location 2 C t4 K,e. s T t ( r r G L /� 9 Lot No.
Owner's name ^)A 0 i e L r'/, 11P Address
3. Builder's name t Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
6. New Porch
L17--1-S-
17.N is existing building to be demolished? /1/ V UT DES
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:- I
/5�
The undersigned certifies jhat the above statcments are we to the best of his
kno edge and belief. /
Signature of respons 1 appicani
Remarks
•'� DEC 2 1 1999 (rifLT of wort 1rt�rnp fan ..:
pZPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212`%fnin Street ' Municipal Building
Northampton, Mass. 01060 ••'••
HOKEOWNER LICENSE EX0-1PTION
l �j ( Please Print)
/
ATE; Z 7
JOB LOCATION:
(Map) ( Parcel ) ( Subdivision)
L,,,/HOMEOWNER: _�A'/JGf L le, L12 -r�'11'
(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 resides or .intends to reside, on which the.•re i-s, 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
colistruets more than 'one home in a two-year . per'iod shall. not be
considered a -homeowner. • Such "homeowner" shall submit to the Building
Official, on a form acceptable to - the Building -Official, Oiat" he/she
shall. be responsible for all such work performed under: the" bui.ldih-
permit.
As acting Construction Supervisor your presence on the: iob site
will be required from time to time, during and upon completiori' o`f 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 Loca 1Zoning Laws , and State of Massachusetts
General Laws Annotated. 1
OWNER SIGNATURE t
i
BUILDING. PEP 41T
� ti tr Via;
i
DEC2 1 199 �iassatkn:el:.
DEPARTMENT OF BUIIDWG INSPECTIONS
'212 Main Street a Municipal Building '
' Northampton, Mass. 01060 '
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
N i e�
(licenswJpermiaee)
with a principal place of business/residence at:
Z ��' , / �
( city/stawZip)
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 worldng 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:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additioml shed ifneceauy to mchrde mfonnihoa peatafaiag to all 000tmdom)
( ) I am a sole proprietor and have no one working for me.
` I am a home owner performing all the work myself.
NOTE:plam be aware that whilo homeowners who employ persons to do=k1enaacq commvaion ortepairvmk on a dwelling of
not mote than tbroe units is vrhich the boamwncr resides or on the grounds appurtenant tberrto moot gamally oomidered to be
employers under the wodwr's compeandon Ad(GL152,ss 1(5))�application by a homeowner for a Haase or permit may evidence the
legal crabs*fan employvt under the Workces Compemation AeL
I understand that:copy of this sbtemma may be forwarded to the Deparb=ot oflndustrial Aa6dam&OX"of hnun-ee for the
coverage vaificstion and that failure to secure coverap udder section 25A of MOL 152 an kd to the imposition of criminal penalli s
comisting of a fine a vp to 51,500.00 an&oc imp<isoexoat orup to one year and civil pemtties in the form of a Stop Wait order and a
Sao of 5100.00 a.day aping Ur-
Fot•depastmmtaluaeooty .
�.
Permit Nwonber
Map# Lot#
Signa�dumnseeJperml Me
10. Do any signs ebst 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 cols to be filled in
by the R—Idi.ag Department
Required I
Existing Proposed By Zoning
L t size
Frontage
Setbacks
- side L• R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lotarea minus bldg
&paged parking)
# of Parking Spaces
# of Loading Docks
Fill:
{vol-ume--& location)
13 . Certification: I hereby certify that the informaw on contained herein
is true and accurate he best of my knowle�e�
D7T Z / APPL AN 's SIGNATURE
N E: Issuanoe of a zonin per does not relieve an applioant's burden to ply witl--,all
ning requirements and btal all required permits from the Board of Health. Conservation
Commission. Department of ublio Works and other appiloable permit granting authorities.
FILE #
pC 1999
Fi1e No. 61,�Q0
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
zi. Name of Applicant: -D A 13 (e- (, i- r';fz�>�
Address: 2 51 F1,,A(a)CP ( 455 Telephone: 58_q- q 7 ZO
✓2. Owner of Property: S.4 M L
Address: Telephone:
Status of Applicant: V/Owner Contract Purchaser Lessee
Other(explain):
Job Location:
Parcel Id: Zoning Map# / Parcel# District(s): 1�
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property �N
v Description of Proposed Use or roject/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- It>< _ 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? N04_ 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-2000-0607
APPLICANT/CONTACT PERSON HARDY DANIEL R
ADDRESS/PHONE 2 LAKE ST (413)584-4720 Q
PROPERTY LOCATION 2 LAKE ST
MAP 17C PARCEL 011 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building,Permit Filled out
Fee Paid afwy
lWeof Construction: DEMOLISH BARN-NO UTILITIES
New Construction
Non Structural interior renovations
Addition to Existina
Accessoy Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
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 Board of Health Well Water Potability Board of Health
Permit from Con ervation Co fission
Signature of Building 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.
s ,i
2 LADE ST BP-2000-0607
CIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C-011 CITY OF NORTHAMPTON
Lot:-001
Permit: Buildinq
Cate o :demolition BUILDING PERMIT
Permit# BP-2000-0607
Project# JS-2000-1082
Est.Cost: $1500.00
Fee: $10.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group:
Lot Size(sq.ft.): 12283.92 Owner: HARDY DANIEL R
ZoningURB Applicant: HARDY DANIEL R
AT: 2 LAKE ST
Applicant Address: Phone: Insurance:
ISSUED ON:12128199 0:00:00
TO PERFORM THE FOLLOWING WORK.-DEMOLISH BARN - NO UTILITIES
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 12/28/99 0:00:00 2900 $10.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo