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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. J (" Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location 1 0 L AK E V" Ct_o Lot No. t��[3
2. Owner's name T C e U 5 z -'t-Ct_t "")Stu Address 5 CL PA e-
3. Builder's name o-^e- Address
Mass.Construction Supervisor's ' ense No. Expiration Date
4. Addition 4' n
5. Alteration
6. New Porch
7. Is existing building to be demolished?
S. Repair after the fire
9. Garage ��� : No.of cars La Size
a� x3
10. Method of�heating
11. Distance to lot lines L,21-+ 5 Je— r / �+��'�+ — 1 O(1� kel"Lr-- 1001 J je
12. Type of roof 5h:kq ke S f
13. Siding
14. Estimated cost:-
- / The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
r
X14"1 z
Signature of responsible appricant
Remarks A,50 D u,V r1 A- C f.,J r1. � +�. )V1�2 �� {" �,� . L-) Y1
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0-� E-fie o s L
Grxk of Nort4M11tptan Z Z
$
51997 �lassacllasetts W
IMa 1
DEPARTMENT OF BUILDING INSPECTIONS
IFFT-OF1 212 Main Street a Municipal Building 'o
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFTIDAVTr
(licenseeJpermittee)
with a principal place of business/residence at:
I- l y?�e-AI e e (phone#)
(street/ciiy/statr/zip)
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 worldng on this job:
(Insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) Gnsvrance Company/Policy Number) (Expiration Date)
(Name of Contractor) (iasvran.ce Company/Policy Number) (Expiration Date)
(attach additional sheet if necenuy to inchxk infvtmadon pMaining to all oorfactm)
( ) I am a sole proprietor and have no one working for me.
e,�k I am a home owner performing all the work myself.
NOTE:please be aware that while homeowners who employ pmww to do maitenance,conahmWon or repair work on a dwelling of
not more than throe units in which the homeowner resides or on the grounds appurtenwt thereto are not generally oowKkmd to be
employers under the world's compensatica Act(GL152,ss1(5)),application by a homeowner for a lioatse or permit may evidence the
legal status of an employer under the Workees Compensation Ad
I underhand that a copy of this statement may be forwarded to the Depnctaowt of lndautriai Amidmbf offioe of lnwraum for the
coverage vmf cati=sad that failure to&asters coverage under section 25A of MGL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to S1,500.00 and/or imprisonmecd of up to one year and civil penalties in the form of a Stop Wodc order and a
fm of$100.00 a day against me.
Signed this J 5� .day of 199 For departmental tree only
VA Permit Number
�-1 ICS Map# Lot#
ignature of Licensee/Permittee \ /
See reverse side for instruetiinns
O O
a� 'e (riff of Yortl7alliptoll
� r
DEPARTMENT OF BUILDING INSPECTIONS
'
IN SPEC Y 199 212 A1nin Strect ' Municipal Building
l
Northampton, Nlass. 01060
��Pl OF Sf s g
HOMEOWNER LICENSE EXEMPTION
( Please Print )
DATE
JOB LOCATION :
(Map) ( Parcel ) ( Subdivision)
HOMEOWNER: TadeL!S Z S� "wSLk!
( Name & Address )
L R K E 5'r. �1o� ce tvl�ZS` 0IC)cc,C--) S�t�
( Home Phone ) (work Phone )
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one ( 1 )or two (2) fami 1 es 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 .
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
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 26 1
BUILDING PERMIT
10. Do any signs exist on the property? YES NO X
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 colw= to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage 'a
Setbacks - frnnt & 5
- side L: ab� R: ct, ,` L:—D(-,' R: ht,S'
• I�
- rear
Building height
Bldg Square footage a(I a 5
%Open Space:
(Lot area minus bldg ? r7 5 0/o (�
' &paved parking)
# :pf Parking Spaces
f Of Loading Docks
Fill:
(vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
_1
1i
DATE: APPLICANT's SIGNATURE p
NOTE: issuance of a zoning permit does not relieve an applicant's burden to comply witt�r,, ll
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public Works and other appiioable permit granting authorities...-
FILE #
a
MAY 51997
File No. % I
DEPT OF BUILDING INSPECTIONS
- - N ' 'AIAT" '� c�aR ONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: lv La�E lcsv eflc� ` (U�Lt. Telephone:
2. Owner of Property: '5- CX-tVe
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: 0tC(OC"',
Parcel Id: Zoning Map# _ Parcel# J District(s):---Z �
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structur roper v-tt.� . Q �9--
6. Description of Proposed Use/Wor rojec ccupation: (Use additional sheets if necessary):
c,J t aLA x 3 Ce &C'rct-�q e , Qc � Twcs ifl�i U C
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_r IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW—'�Z— YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO_ 5� 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 # 9619- 5 3
NN
LIC NT/C} N ACT PERSON:
DEPT
NQRINAMP�^°�!:_P+iR QI.GfiQ
^PROPERTY LOCATION:
MAP PARCEL:-- E;® ZONE
THIS SECTION FOR.OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Fee Plid
Tliiildin2 Permit Filled mit
Fee Paid LIM
ArressnryStriirtime
i
L.
THE�OLLOWING ACTION HAS BEEN TAKEN ON THIS APE LICATIOM
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-Bd of Health Well Water Potability-Bd Health
Pe t from onservatio ssion
Signature of Building for Dat
NOTE:tssuanoe of as zoning permit does not relieve an applioant's burden to oompty with all
_ zoning requirements and obtain all required permits from the Board of Health, Conservation
Commisslon, Department of Publio Works and other applionble permit granting authorttlas.
City of Northampton REQUHZED INSPECTIONS
! a 1. Footings and Walls
BUILDING DEPARTMENT 2. Structural Components in Place*
I Complete Building*
No. 410
Office of the Building Inspector
Zoning Form No. 962253 Date.5/20/97 Fee$86.00 Check# Money Order
Page, 17A Parcel 250 ,Zone URB Section 127 ❑ Yes ® No
BUIULDINGPERM, IT
*Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Tadeus Stankowski before Building Inspections
has permission to construct detached 24' X 36' garage Inspection on Site—Foundations
situated on 108 Lake street Inspection of Plumbing—Rough
provided that the person accepting this'permit shall in every respect Inspection of Plumbing—Finish
conform to the terms of the application of file in this office, and to the Gas Inspection
provisions of the Statutes and the Ordinances relating to the Construction, Inspection of Wiring—Rough `
Maintenance and Inspection of Buildings in the City of Northampton.
Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring—Finish
of this pen-nit.Expires six months from date of issuance,if not started. Building Inspection—Rough
Note:A certificate of occupancy will be issued by this office upon return Insulation Inspection
of this card signed by the Plumbing,Wiring and Building Inspectors.
Building Inspection—Finish C K
Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A SNSPIC OUS PLACE ON PREMISES
Certificate of Occupancy
Bu' ding Inspector