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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 2 «E z Lot No.
2. Owner's name ddress 2 1,1tW- ST: ,
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteratign
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:- $s 00 ' sJ�
3 °z
The and i nifies that he a e tatcmcnts are we to the best of his, i
knowle and I ef.
Signature of responsible app,icant
Remarks
I
Gl ifs of Nartlra»tpfall r ,
� �iasssdtnsttla
K10 1 7 1;i 3 DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR -
212 Main Street ' Municipal Building
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
DATE: ,/ 2 I (Please Print)
JOB LOCATION:
(Map le -P, rcel) ( subdivision)
HOMEOWNER::. CV jj��1 d4 � -/ �A.N14,
n (N & Address )
7
XA
7
L�'�c is! / >�
ly
(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 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( s ) you hire to perform work for
you under this permit.
The undersigned "homeowner" certifies and assumes responsibility
is for compliance with the ,.State Building Code, City of Northampton
Ordinances, State and Loczk1 Zonng ,L Lws, nd State of Massachusetts
General Laws Annotated rr,-
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HOMEOWNER SIGNATURE -('1;N
BUILDING PERMIT #
Ila' ;,,
��nn>rpT
a 0'a Gif,r f i�x#I tt1�t nit i
DEPARTMENT OP BUILDMG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WOR-WER'S oMrENI SATTON INSMR -NCE AFMAVIT
(licensedperM Itec)
vrith a principal place of business residence at:
(phoned)
(Stm:! /city/staLchiP)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the folio«ring wor-kcr's compensation coverage for my ,
employees working on this)ob-
onsl ance Company) (Policy NIL-mh21) (Expiration Date)
( ) I am a sole proprietor, general contzactor or �omeowgef c le one) and have hired
the contractors listed below who hi=ve the foud - orker's compensation policies:
=tom
(Nam-, of Contractor) (lnsa nog Compamy/Poky Nuin cr) (E-\-)iradou Date)
(IN"Ine of Cowfa ctor) (IPSL':anc; conioculyfpOiC Nu-nit-21) (Exoiranoa Date)
(Name of Contractor) (lnsw-any Company/Poticy Numbu) (Exp.Lra6oa Datc)
(Name of Contractor) (Insurance Comoagy/Policy htumbe..r) (Expiration Date)
(euach:Milimzl lh- '(if ococaary to inchxk ict"ccmilicn pcztzining to al!wdjaCO-�)
( am a sole proprietor and have no one worEDo for me.
( ) X am a home owner performing all the work myself.
NOTE:please be nwa c that whilo ho ,%-OCT-3 wt)o cmptay pcxurm to do m.„r,--,.,,n coaiuv oa or rcp� work on a d-xUiag of
not moec then tbnao traits in whiefr the bomomtvee raiw or oa the p cuods appartc�nt tbc- °arc co(CCnar lly oom idcrod to be
catployrn under tha-Deject`'ocaspc z-,tica Act(GL1523a 1(5)),application by a homcowv r for a bccasc o<pCnDH may cvidcooc the
legal ct-IItt of an-=ployoc under tbo Woes t CooapcaaAioa Act_
[aadCrstaad that a copy Of A"mscmmt may be foMVj Ltbd to the Departmcnd of Lodusoial Anadooef Offioo of 4:wraoos for tbo
oovgx.8e vrrifieali_oa aad that Mum to soasre covar4v under soetioa 75A of MOL 152 Can lead to tbd kV0=*dioa of almmsl pw-116-
oomistiag oC f up to S 1,SOO,pO sad�or of tip to one year.wd civi]pcmllia is the form of a Stop WodcOtdcr ind s< '
fism oCSI - ' y>_gsiaA c
tu t
. Foe daputhrnbJ u�o only
Pcimit Number
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10. Do any signs exist on the property? YES NO V
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 Col.== to be filled in
by tha Building Department
Required
Existing Proposed By Zoning
Lot size C'/, •_�/ -1 - J � � -7
Frontage
Setbacks
- side L• R: L: R: Jul
- rear
Building height
Bldg Square footage 1�70
%Open Space:
(Lot area minus bldg
&paved parking (P
# of -Parking spaces 1
f of Loading Docks
Fill:
(vol-ume--& location)
13 . Certification: I hereby certify that the info ion cont i d herein
is true and accurate to the best of my know e
C-'
DATE: ' 1.� APPLICANT's SIGNATURE R
NOTE: Issuanoe of a zoning permit does not relieve an applioanYs b rden o oompty wit �4t1
zoning requirements and obtain all required permits from the Board of Health, Conserva
Commission, Department of Publio Works and other applioabla permit granting authorities.
FILE #
.i
g
Fi 1 e NOO 9
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant J �': A . ly A(�F--'
Address: `7 /_ IgKF- 2 FT: r l fephone: `) E f'
2. Owner of Property: O I:�r `
� p
Address:s7 L'9C.'r-- z: -- Telephone:
3. Status of Applicant: 1/ Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: F -
Parcel Id: Zoning Map# 1 Parcel# / T District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
.y 7
5. Existing Use of Structure/P rope rtyt-
6. Description f Proposed Use/Work/Pro'ecUOccupation: (l se additions eets if necessary): l
rte'
i J
1
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 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 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-1999-0498
APPLICANT/CONTACT PERSON Robert Stanavage
ADDRESS/PHONE 586-3038
PROPERTY LOCATION 57 LAKE ST
MAP 17C PARCEL 015 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOS p REQUIRED DATE
ZONING FORM FILLED OUT ✓✓
Fee Paid
Building Permit FiI1W out
Fee Paid 0
Type of Construction:
New Construction U
Non Structural interior renovations
Addition to Existing,/ldz
Accessory Structure
Building Plans Included:
Owner/Occupant Statement or License#
3 sets of Plans/Plot Plan
THE]jOLLOWING 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 Conservat' n mmission
/e z
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.
Department: Reference No- BP-1999-0498
...................................
Building, Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
shed REC-1999-001351
... .....................................................................................
Paid By: Paid'i'n*...F...u`1'1...0...n':...........
Robert Stanavage Wed Nov X18,1998
.........................................................................................
......................................
Received By: Check No:
Linda Lapointe M086823
.........................................................................................
......................... ............
DEPARTMENT'S COPY Amount: $40.00
---------------------------
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DEPARTMENT FILE COPY 57 LAKE ST
CITY OF NORTHAMPTON
BUILDING PERMIT
Owner's pulling their own permits or dealing with unregistered contractors for applicable work do
not have access to Guaranty Fund(MGL 142A)
Issued: Permit No: Inspector: Tracking No.: Fee:
BP-1999-0498 $40.00
GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size:
-
1650 177_ V01 57 LAKE ST URB 9321.84
Contractor: License Type: Insurance:
Homeowner as Contractor
Address: License No.: Insurance No.:
City: State: Zip Code: Phone:
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0954 shed $6,300.00
Description of Work:
20 x 14 Shed & strip & shingle roof
GeoTMSV 1997 Des Lauriers&Associates,Inc. Signature: