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17C-143 (2) O4�t1AMp�O $ � �6lussacllrrsctts 5T DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street • Municipal Building Northampton, MA 01060 Applicant Information�(�,� ,� Name—5LM-- [1UA2 ------------------- Lo c at i o n r L�2a ------------------- C it y 1-0ce �I am a homeowner performing all work myself ❑ I am a sole proprietor and have no one working in any capacity ❑ I am an employer providing workers' compensation for my employees working on this job. Company Name--------------------------- Address City----------------__— Phone# Insurance Co.-- _—Policy#----------_ Company Name Address City Phone# Insurance Co. Policy# Failure to secure coverage as required under Section 25 A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1500.00and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day againstme. I understand that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pairs and penalties of perjury that the information provided above is true and correct. Signature Date Print Name �t. a*144 ) Phone# Official Use Only,..Do not write in this area to be completed by city or town official C City or Town Permit/License# ❑ B-Idirtc Dept ❑Li erasing Board Check if immediate response is required — Contact Person Phone# ❑�� ' E] Health Dept. r �: \\ / \\!� � ! 1 r \ �\,\�\ f\\ ' \ i!� ;/ \ /J�\ \ J `.\ i 1 /� �•\l \ �I r\ 1/ ., \\ rte, r �'n, � \ \ \ �-_..._ / \\ '�\ 1 \ ! VVIIN/ / V //IVPVA\ ",A\ ; All ! % \ _ \\:\ \ \ \ `—/\a`r`t,-\ \ / \ ! ! \ \\} / qq . \ VR«m, / . � . ,.� \\\\\\2\y\2 2 Z/X 4/ : - © COY, ) � } � . Sti,�''� Sl�ih� � � �1 s,S�� .,.�,5 �g ��,��I ��� -�r+r-r�8 },��nw►� 5���1..f 41 7n� . rm co Tr or XZ N61 Z � _ gxz �y. 6u�1fiX.:/ of �a M m i cam? 70 ¢,r 04 t 3 c Z m Z 3 LL cn O `D Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. �' Alterations NORTHAMPTON, MASS. � // 19 Additions APPLICATION FOR PERMIT TO ALTER Repair 4 r Garage 1. Location / 22- A/ / & 1V ST Lot No. 2. Owner's name .5 c 6l-T J O Ana al-i Address l,2 � /T/`Gti ST 3. Builder's name 5A /M 6 Address SA rf Mass.Construction Supervisor's License No. ,�� Expiration Date AIA 4. Addition 5. A_lterrafion ��`NePo " w 7. Is existing building to be demolished? /I/ 8. Repair after the fire ,y 9. Garage /V o No.of cars Size 10. Method of heating &A 11. Distance to lot lines o;�'ROW /1-/'7 :�»� ` OZ 71 Q,.r SAC, �U �•S 12. Type of roof IV A 13. Siding house 14. Estimated cost; (] The undersigned certifies that the above statements are we to the best of his, i knowledge d belief. Signature of responsible app icant Remarks g� MAY 1 21999 Y it' Crif of wortl1amp fall $ •e DEPT OFBUf1 {;IA+Sasescitusette EPT CAS " --° •A��` � o-9 J EPARTMENT OF BUILDITIG INSPECTIONS INSPECTOR 212 Main Street ' Municipal Building '- Northampton, Mass. 01060 HOMEOWNER LICENSE EXEMPTION (Please Print) DATE: / /� /� JOB LOCATION: ! f / "/ �/ !1 U. . �., Ma (Parcel) (Subdivision) HOMEOWNER: eo _ (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 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 gprson who • constructs more than 'one home in a two-year . period sha-11 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 buildiiiq permit: As acting Construction Supervisor your presence on the. j:ob 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 for compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws , and State of Massachusetts General- Laws Annotated. � HOMEOWNER SIGNATURE BUILDING PERMIT # JAZ "16H ST Fi6#thtc S PR P ERTY 1.45 174 131 Ho USE 7v 1 , �3' fy, l2y ' #1W neck LAY OWT rm ao 3 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__K IF YES,describe size,type and location: 11 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. This cola= to be filled in by the Building Department I Required Existing Proposed By Zoning Lot size ��j q r7 � Frontage !� 9 / 7 Setbacks - ? ' b j S'r - side L:Z.. R: L: / R: - rear Building height . ,. Bldg Squareµfootage �.. . c>y e %Open Space: _ (Lot area minus bldg r"` &paved parking) # of Parking Spaces # (of Loading Docks Fill: -{volume -& location) -� 13 . Certification: I hereby certify that the information contained herein 4 is true and accurate to the best of my knowledge . 1 DATE: -It r�i� APPLICANT'S SIGNATURE "a3 " NOTE: Issuanoa of at zoning permit does not relieve an applicants b den to comply With all zoning requirements and obtain all required permits from the Board of Health. Conservation Commission. Department of Publio Works and other applioable permit granting authorities. FILE # " 'TM l ly .w��• 8 Lj MAY 12 M File Noj 9 PT OF S!.Isi c IN,"17 ITIO dS ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION r 1. Name of Applicant: 5LM A :IANW-U c Telephone:L q� ) Address: T�o e 2. Owner of Property: 5cal A.� JV i fief A 30 off.`QA Address: 1�LQ. {hli 1 .+f Telephone: / 3. Status of Applicant: �X Owner Contract Purchaser Lessee Other(explain): c 4. Job Location: r 9l Parcel Id: Zoning Map# � Parcel# District(s): (TO BE FILLED IN BY THE UILDING DEPARTMENT 5, Existing Use of Structure/Property 'S r�/ 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): ice 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/Vadance/Finding ever been issued for/on the site? NO_ X_ DON'T KNOW YES IF YES,date issued: IF YES: Was the permit recorded at the Registry of Deeds? w 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-1999-0951 APPLICANT/CONTACT PERSON JOHNSON SCOTT A&KATHERINE A ADDRESS/PHONE 122 HIGH ST 5861627 PROPERTY LOCATION 122 HIGH ST MAP 17C PARCEL 143 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid :1 l Typeof Construction: CONSTRUCT 14 X 16 DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure - Building_Plans Included• Owner/Statement or License 3 sets of Plans/Plot Plan THE LOWING 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 Commission Signs 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. 122 1 3161 1 S"l BP-1999-0951 GIs 4 _ _ COMMONWEALTH OF MASSACHUSETTS Map-.Block: 17C- 143 CITY OF NORTHAMPTON Lot: -001 Permit Building Cate (,i-, ',iltrration-edition BUILDING PERMIT Permit BP-1999-0951 Projc + JS-1999-1622 Est.Cost: $1000.00 Fee: $110 00 PERMISSION IS HEREBY GRANTED TO: Const. Ci,t,,,,: Contractor: License: Use Grwq):- Lot size(,"CL ft.): 11891 .88 Owner: J01 NSON SCOTT A&KATHERINE A Zonin':_� �:_t3 Applicant:_ AT: 122 HIGH ST Applicant Address: Phone: Insurance: ISSUED ON.51ml1999 o:oo:oo TO PERFORM THE FOLLOWING WORK:CONSTRUCT 14 X 16 DECK POST ['HIS CARD SO IT IS VISIBLE FROM THE STREET Inspectw- of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Under-round: Service: Meter: Footings: Rough: Rough: House# Foundation: Final: Final: Rough Frame: Gas Fire Department Fireplace/Chimney: Ro wo h: Oil: Insulation: Final: Smoke: Final: THIS PVRMIT MAY 13E REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy silinature: Fee T) pe: Receipt No: Date Paid: Check No: Amount: BuildinL- 5/14/1999 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo