17C-002 (5) �0Q,SjGy
of Wart 11ampton
$ 6 O �xssxkltnsrtfs
m 0 DEPARTMENT OF BUILDITNG INSPECTIONS
212 Main Street ' Municipal Building '
42 Northampton, Mass. 01060
G R'S COMPENSATION INSURANCE AFFIDAVIT
(licenseelpermittee}
with a principal place of business/residence at:
(street/city/staff)ip)
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 o omeo (circle one) and have hired
the contractors listed below who have the following wor ees compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) Gmsu=ce Company/Poky Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (E)piration Date)
(attach additional shed if necessary to include information paan;ning to all ooatradors)
( ) P6jn 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 homeowners who employ persona to do maineaance,faction or repair work on a dwelling of
not mono than throe units in which the homeowner resides or on the grounds appurtenant thereto are not generally considered to be
employers under the wodw s compensation Ad(GL152,ss 1(5)),application by a homeowner for a lioc=or permit may evidence tho
legal status of an employer under the Worker's.Compemation Act
I understand that a copy of this s.tatemeni may be forwarded to the Depertmcu¢of Inda=trial Ao6da&Office of Insurance for the
coverage verification and that failure to sonar a coverage under section 25A of MGL 152 can kad to the impositioa of mmmal peoaltica
comisting of a fine of up to$1,500.00 and/or imprisonmezu of up to one year and civil pcn Wes in the form of a Stop Work order and a
fine of S100.00 a day against tne.
For depattM=W use only
Mt.? Permit Number _
�(f 06L / t.? Map# Lot#
Si of L" 'tree Date
a� 'e Crif� of 'Narillailypfoil
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DEPARTMENT OF BUILDING INSPECTIONS
` 312 Main Street Municipal Building
INSPECTO
O Northampton, Mass. 01060
,c HOMEOWNER LICENSE EXEMPTION
' (Please Print )
DATE•
JOB LOCATION: -
(Map ( Parcel ) ( Subdivision
HOMEOWNER: TeS /t'�on t� S • ���nC c°
(Nam' & ress) �� s '-7J.• o�
(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- bui°ldirig
permit'.
As acting Construction Supervisor your presence on the. job site
will be required from time to time, during and upon completion" 6f 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.
t
HOMEOWNER SIGNATURE
BUILDING. PEtMIT # �1s
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
'
' APPLICATION FOR PERMIT TO ALTER Repair
, I I Garage
/7
1. Location LAO Q� St r(C>r f nc c- � t, Lot No.
2. Owner's name Se AA dAclowler� Address Li& C-eK S4-
3. Builder's name Address
Mass.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 See A 1 lK--A1
12. Type of roof
13. Siding house
X14. Estimated cosL- � Jrp
The undersigned certifies that the above statcments are we to the best of his,
knowledge and belief.
St natu a of responsible app,icant
Remarks 1---' AIL-1-1- 4--Z3r' ! 'r (f-2t, (954- of. ty &I �t �" t'C A/
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-NOTE-
THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT
TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED.
BUILDING LOCATION ACCURACY IS NOT GUARANTEED
34t.d,3.
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TO: SPRINGFIELD INSTITUTION FOR SAVINGS &
FIRST AMERICAN TITLE INSURANCE COMPANY
TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF
I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES,
EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
COMMUNITY #
250156 —NOTE-
li? PLAT FOR MORTGAGE LOAN PURPOSES ONLY
SURVEYOR: �' �" AND DOES NOT CONSTITUTE A PROPERTY SURVEY
MORTGAGE LOAN INSPECTION PLAT—
NORTHAMPTON, MASSACHUSETTS
RAN PREPARED FOR
Z. y EDWARD B. SKROSKI
I
035032 SCALE: 1 "=40 ' JULY 6 , 1998
l�N�RV al HAR L. EATON AND ASSOCIATES, INC.
REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET- — HADLEY — MASSACHUSETTS
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 colas to be fill d im
by do Building Depazt=aent
Required I
Existing Proposed By Zoning
Lot size
Frontage
Setbacks ' Z a
- side L:_JR: L: 7 R:;:P-V
- rear � � SY z o
Building height f
a� .
Bldg Square footage f 3 7026
%Open Space: pr g
(Lot area minus bldg
Sa
&p?ved parking) 2v cJ
# of Parking spaces
f of Loading Docks
Fill:
{vol-ume--& location)
13 . Certification: I hereby certify that the information conta ed herein
is true and accurate to the best of my knowledge.
D70E: A) , 94 Witt APPLICANT's SIGNATURE
NOTE: lssunnoa of a zoning permit does not relieve an ap o nY ur n to comply witl� all
zoning requirements and obtain all required Perm he o Health. Conservation
Commission. Department of Publio Works and other appii able PGVqfQt granting authorities.
FILE if
103 01999
�i_PT OF$li p.
Fi 1 e No 6-651*
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
�C'SSC lQ�'�
Address: Li 6 0� S4 Telephone: S S—Oo`9CP
2. Owner of Property: 5""-4e
Address: / _Telephone:
3. Status of Applicant: V Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: _
Parcel Id: Zoning Map# ./ 7�2, Parcel# 60"/2— - District(s):�Gyl
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property h*CliC64t-1-`1
6. Description of Pro ose Us /Work/Projec Occupation: (Use/additional sheets if necessary):
�v✓�S�ii�� IVdr.7 scvU�°5 40 �v,l , /1lCt✓ la.�lA� pcL �� �n 1 �"
�T" ReplliCC 3-n l✓1 w c c C�•-•-� C �3Sjp T ru 54 1 st//�c.r cSi�Ci�7� o�57U
1 T
We6�,0 3cm C&o rn �{ 'X 7 / L�) cj)-v 6LU1 r4 All ate^ xc�n -� S u 1.qtx e4��/ c9v
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 PP mit/Vanance/Finding ever been issued for/on the site?
NO V 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 KNOVV 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-2000-0563
APPLICANT/CONTACT PERSON MONTGOMERY JESSE
ADDRESS/PHONE 46 OAK ST 585-8482
PROPERTY LOCATION 46 OAK ST
MAP 17C PARCEL 002 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildina Permit Filled out
Fee Paid
T eof Construction: ADD 12 X 12 DECK REBUILD FRONT PORCH 12 X 8&SUNROOM 13 X 7 INSTALL
ROOF REPLACEMENT WINDOWS&DOORS&SIDING
New Construction
Non Structural interior renovations
Addition to Existing
Accessm Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE,�LLOWING 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
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.
Y 4
46 OAK ST BP-2000-0563
GIS#: COMMONWEALTH OF MASSACHUSETTS
r"jg2:Block: 17C-002 CITY OF NORTHAMPTON
Lot:-001
Permit: Buiidina
Category: alteration-addition BUILDING PERMIT
Permit# BP-2000-0563
Project# JS-2000-1003
Est.Cost:$11950.00
Fee: 50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group:
Lot Size(sa.ft.): 19602.00 Owner: MONTGOMERY JESSE
zoning URB Applicant:
AT. 46 OAK ST
Applicant Address: Phone: Insurance:
ISSUED ON:1219199 0:00:00
TO PERFORM THE FOLLOWING WORK.-ADD 12 X 12 DECK,REBUILD FRONT PORCH
12 X 8 & SUNROOM 13 X 7, INSTALL ROOF,REPLACEMENT WINDOWS & DOORS & SIDING
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 sienature:
Fee Ty
pe• Receipt No: Date Paid: Check No: Amount:
Building 12/9/99 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo