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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER• Repair
/ Garage
1. Location zz L ��, � L / Lot No.
2. Owner's name -TJ Address
3. Builder's name c �' Address G�Z4e- & r-
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
6. New Porch
7. Is existing building to be demolished?
S. 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 5�r�-cae
(�C�e` e undersign ies that the above statements are we to the best of his.
knowled and belief _
Signatu onsib/t ap icant
s Remarks c4=71,0
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cr —,,D$PARrMENT OF BUILDING INSPECTIONS
=I fain Street • Municipal Building
"""°""`"Northampton, Mass. 01060
�. WORKER'S COMPENSATION INSURANCE AFMA I'T
(licenscdpermittcc}
with a principal place of business/residence at:
- (phone#)
(stic--t/ci ty/staff ehi P)
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 working on this job:
(Insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or Komeowner�elrcle one) and Have hired
the contractors listed below who have the following workC1-S compensation policies:
(Name of Contractor) (Lusur'anc-- Company/PoUcy Nu_mbcr) (Expim6on Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/pohcy Number) (Hxpumdon Date)
(Name of Contractor) (Insurance Company/Poky Number) (Expiration Date)
(atIach additional sheet if nooc—xy to include MfoCmslioa pcstainiag to all o«s racoon)
O I am a sole proprietor and have no one working for me.
Q I am a home owner performing all the work myself.
NOTE.plczac be aw-uc that whilo boaxxm era who mzploy pasoas to do m• ica3cr Coc5'suc6on'or repair work on a dwcUing of
not nioro than throe units in which the hour owner mides or on the goua zppuit nud thcrc &M oo(grncrally ooasidcrcd to be
rmPloyas under the wmkcs"s icn Act(GL152,=1(5)x,application by s homeowner for a Ucawc cc pumif may cvidcooc tbo
Itga1 status of as omPloyec under thn Woricda C.o¢ipomalioo Act
I un&rxts ad that a o Vy of tbu rW=acct may be fwwwded to tbo Dcpertmmd of Indzr a1 A&6d Ofiioo of Imur■aoe for the
COV-9c.VmGcatioa and that fadure to soatre Bova-a o undo soctioa 25A of MOL 152 can lad to tbo'k*ositioa of aimia+l_Penalties
_.. O0°uTtME olx-fmo bfuP to S1,500-00 and/or imPr-60=3-t of uP to oat year and civil Pcnatia is the form of a Stop Work order and i
fund 0(5100.00 a day against nom•
For dqmtmmW use only
Pcrmit Number
L .t Nfap4 Lot 4
. r Si of LicenscejPcrnutt=
x.
a� .. Crif� laf Xvirfilallrpfall ,
X S b B Ch list D
egg DEPARTMENT OF BUILDING INSPECTIONS _
INSPECTO 212 M'nin Strcct ' Municipal Building
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
( Please Print )
DATE:
JOB LOCATION:
(Map) (Parcel ) ( Subdivision )
f
HOMEOWNER: -
(Name & A dress )
`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 . MUM 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 buiidinq
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 (G9orkers '
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
�j General Laws Annotated.
v� HOMEOWNER SIGNATURE
BUILDING. PERMIT s
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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 MAST BE COMPLETED, or PERMIT CAN BE DENIED DUE To
LACK OF INFORMATION.
Tbis columm to be filled in
by the &uilding Department
Required
Existing Proposed By Zoning
4" 4;, '
Lot size
Frontage
Setbacks
t
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&peved parking)
# of -Parking spaces
e of Loading Docks
Fill:
_{volume--& location)
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
2
DATE: L3
DATE: APPLICANT's SIGNATURE ,
NOTE: lssuanoe of a zoning permit does not relieve an a lioant's burden to oomply Wit4-all
zoning requirements and obtain all required permits from the Board of Health. Conservtition
iCommission. Department of Publio Workm and other mpplloable permit granting authorities.
FILE #
3 0 199?
Fi 1 e No.
20NTNG PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
�\
1. Name of Applicant: �J � i �r
Address: J,2— Telephone: Sylt--96-1-1,11�
2. Owner of Property: ;� ..
Address: Telephone:
3. Status of Applicant: //Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# - Parcel# 4� District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Dew scription of Proposed Us ork roject/Occupation: (Use additional sheets if necessary):
ow
7. Attached Plans: lam'' 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?
O DON'T KNOA1_jZ 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)
File#BP-2000-0006
APPLICANT/CONTACT PERSON STARK JUDITH A&JAMES D
ADDRESS/PHONE 12 LAKE ST
PROPERTY LOCATION 12 LAKE ST
MAP 17C PARCEL 012 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
lypeof Construction: CONSTRUCT ROOF OVER STOCKADE FENCE ON DET GARAGE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure -
Building Plans Included•
Owner/Statement or License
3 sets of Plans/Plot Plan
T OLLOWING 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 * ission
Signa a of Building Official Dat
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.
12 LAKE ST BP-2000-0006
GIS#: COMMONWEALTH OF MASSACHUSETTS y
Ma p-Block: 17C-012 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:renovation BUILDING PERMIT
Permit# BP-2000-0006
Project# JS-2000-0007
Est.Cost:$500.00
Fee: $20.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group:
Lot Size(sq. ft.): 19645.56 Owner: STARK JUDITH A&JAMES D
Zoning:URB Applicant.
AT: 12 LAKE ST
Applicant Address: Phone: Insurance:
ISSUED ON.•716/1999 o:oo:oo
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT ROOF OVER STOCKADE FENCE ON DET
GARAGE
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 7/6/1999 0:00:00 $20.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo