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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 7,/( y 19� Additions
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APPLICATION FOR PERMIT TO ALTER eGmge
1. Location (��o /V 14144 if- �'J— ), Lot No.
2. Owner's name Address rc) /V
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 �Vo
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:- C
0 0
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief. .....I............
Signature of responsible app,ica,11--
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., DEPARTMENT OF BUILDING iNSPECTIONS - =1
DEPT OF 811=
1NSPECTO R;0 212 Main Street ' Municipal'Building
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE: /�//y ��
JOB LOCATION:
(Map) / /( Parcel ) ( Subdivision)
HOMEOWNER: '00,V,9 c )c 16.E D 6r-s
(Name & Address )
U Al- /blsr ,I e-° S i 1 r—( ('�/ 3)
(Home Phone) (Work Phone)
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one ( 1 )or t«o (2) fami 1 ies. and to allow such
homeowner to engage an individual for hire who does not possess a •
license, provided that the owner acts as suP-'1rvisor . 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 tbro 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
all be responsible for all such work performed under the building
permit.
As acting Construction Sup ervisor your presence on the job site
Will be required from time to time , during and upon completion of the
Mork 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 Mass,.chusetts General Lads
Annotated , you may be liable for vcrson ( s ) you hire to perform work for
you under this permit .
The undersigned "homeowner" certifies and assumes responsibi-lit-y
for compliance with the State Building Code, City of .Northampton
Ordinances , State and Local Zoning Laws, and State of Massachusetts
General Laws Annotated.
HOMEOWNER SIGNA`.I-'Y7R_E -'
BUILDING PERMIT ##
04
Grxt� of 'Wart alliptuIt
JUL t 6 11998
,,,,� laa4irrltnSrlt4
u, EAARTMENT OF BUILDING INSPECTIONS
DEPT OF B J INSPECTION I,
P#ORTFi 01� 12 Main Street ' Municipal Building 'a
Northampton, Mass. 01060
WORICER'S COMT/ENSATION INSURANCE AFFIDAVIT
(Iic,n, permittee)
with a principal place of business/residence at-.
�( /1/ /`'!f1/� (phone#) 6
(str=Ucity/statehrip)
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 Dais)
I am a sole proprietor, general contractor homeowner cle one) and have hired
the contractors listed below who have the follow 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)
(nttadr additional sled ifnecenary to inc}trde infer .n pertaining to all ooesractors)
( ) I am 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 wElo homeowners who employ persons to do maintmxnce construction or repair work on a dwelling of
not more than throe units is winch the homeowner resides or on the grounds appurtenant therrto arc not generally coasidemd to be
employers under the worker's oompenu4 a Ad(GL152,ss 1(5)),application by a homeowner for a Haase or permit may evidcnoe the
legal statue of an employer under the Worker's Compensation Act
I understand that a copy of thin uatemens may be forwazded to the Department of Industrial Ac6dan&0J1i0o of Innaanoo for the
coverage verification and that failure to sceure covenrge under section 25A of MGL 152 can lead to the ikon of criminal penalties
oomisiiug of a fine of up to S1,500.00 and/or impriso=[naad of up to one yew and Civil penalties in the form of a Stop Work Order and a
fim of 5100.00 a day against the
For deputmW use only
Permit Number
map# Lot#
ten ignature of LicenseelPermittee
fir::
10. Do any signs exist on the property? YES Nd
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 COMPLE'T'ED, or PERMIT CAN BE D.EIITIED DUE TO
LACK OF INFORMATION.
Thi= —1— to be filled in
by 7th- Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
# .pf -Parking spaces
f of Loading Docks
Fill:
(vol-ume--& location)
13 . Certification: -Thereby certify that the information contained herein
is true and accurate to the best of my know
j
DATE: � {q ZC1 0 APPLICANT's SIGNATU
NOTE: Issuanoe of in zoning `
g permit does not relieve an applioanYs burden to oompfy with .al
zoning requirements and obtain all required permits from the Board of Health. Conservtatio
Commisslon. Department of Publio Works and other appiioable permit granting authorities.
FILE #
6 1 File No.��%�'
DEPT OF Rz :r`, „•
wa ; ; ZONING PEPMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 90sA- 1 L-D
Address:l D Al- 1-7,ejr(-X- 5=, Telephone: 6 �FG--
2. Owner of Property: rA/''I'g-
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: e-p AX 1z
Parcel Id: Zoning Map#_/qd- Parcel# �317 District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTME
5. Existing Use of Structure/Property % A'-4 Cgr
6. Description of Proposed Use/Work/Project/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 PermitAlariance/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 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)
Department: Reference No: BP-1999-0096
...................................
Building, Electrical &Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Roofing REC-1999-000162
.........................................................................................
..... ................................
Paid By: Paid in Full On:
Ronald Hodges
,Fri Jul 17,1998
.........................................................................................
......................................
Received By: Check No:
Linda Lapointe 3237
.........................................................................................
......................................
DEPARTMENT'S COPY Amount: $40.00
...........................
DEPART.W.�'N"I' FILE COPY 60 NORTH MAPLE 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:
17 Jul, 1998 BP-1999-0096 $40.00
GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size:
1770 17C 137 001 60 NORTH MAPLE ST URB 11151.36
Contractor: License Type: Insurance:
Homeowner as Contractor
Address: License No.: Insurance No.:
City: State: Zip Code: Phone:
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0137 roofing $3,000.00
Description of Work:
STRIP & SHINGLE GARAGE ROOF
GeoTIVIS@ 1997 Des Lauriers&Associates,Inc. Signature: