Loading...
17A-247 Gi of LYZ� M11t tQ11 DEPARTMENT OF BUILDrNG INSPECTIONS ' pF guB.D!NG 1NSPECTI NS 212 Main Street Municipal Buildin ' OE hf DRTHA° 7C1 w P 9 Northampton, Mass. ' 01060 ` WORKER'S COPdTENSATION INSURANCE AFMAVIT (licenscrlpermittee) with a principal place of business/residence at: % o'l,,U � —z (phone#) (street/ci ty/statrJri p) 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 Dale) ( ) 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 Comparry/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) (E)piration Date) (attsch additioml zbect if noccxsary to inchsdo information pestr i to all coatradon) ( ) I am a sole proprietor and have no one working for me. t ) I am a home owner performing all the work myself. NOTE:picau be await that v+hilo bomcow'ncn who cmplay pKxsom to do—%Mr•=000st uctioa-cr rcpxir worst on a dwclling of not man than ttune uaiu is which the horaww ow residm or oa tho Vrwn 4s%Vurteosm tbrtcto am cot gcoaslly--idacd to be anploycn under the%wkees oompcasatica Ad(GL152,=1(5)).application by a bomcowmi r for a Hoare or P-3k may cvidcacc the lepi datua of an employer uoder the Wmicces Compamatioa Ad. I undmuild that a copy of this ct dcmaa may be for wwxtbd to tbo Dopact rant of Ind, -1 Aaddm 01Sae of L=ucaow for t5. oovaage vcrificdioa and that failure to sown cov=-%V under zoctioa 25A of MoL 152 an lad to the impoa—of aiminal p-attics :a oomisti of wine bf up to 31,5w 00 an&or imprisoameai of tip to one ycar and civil pemltia in the fog of a Stop Wads Order and a fit»of 5100.00 a day lFor dcpastk=cblU"0WY PcrmitNumW Map# Lot#E a z rn m z 0 3 0 0CA Z m © _ t^ et) -, in Z > > 1 = tn0 rn �. X � c Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MASS. 19 Additions Repair APPLICATION FOR PERMIT TO ALTER i �/ / Garage 1. Location��,ke r / 1U�.�C'-e- 414 4 �f f) '— Lot No. 2. Owner's name Address 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 12. Type of roof 13. Siding house 14. Estimated cost co The undersigned certifies that the above statements are we to the best of his. knowledge and belief. 7 Signature of responsible a p icant r ` Remarks / 0 Crlf� of xarflit�m}�fai� P RTMENT OF BUILDING INSPECTIONS �[IOOf gUllDlNG INS 01060 Main Street ' Municipal Buildin g INSPECTOR ' •, Northampton, Mass. 01060 HOMEOWNER LICENSE EXEIdPTION 3 (Please Print ) DATE ` JOB LOCATION: -ZC � ((Map) ( Parcel ) ( Subdivision ) HOMEOWNER: YgRKA16-A) t2 J,09 ? ��a OX (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 i-s, 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, tho bui°ldiriq 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 Law, , and State of Massachusetts General Laws Annotated. HOMEOWNER SIGNATURE --- BUILDING. PEAtMIT # .1 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 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 is by tha Banding Department Required Existing Proposed By Zoning Lot size Frontage Setbacks - frnnt - side L: R: L: R: - rear Building height Bldg Square footage %Open Space: (Lot area minus bldg &paved parking) # of 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 DATE: APPLICANT's SIGNATU NOTE: ls4uani644 of a zoning permit does not relieve an appiioant's rden t mply wit4 .4111 zoning requirements and obtain all required permits from the Board of Health, Conservtation Commission, Department of Publio Works and other applioable permit granting authorities. FILE # a �,�r 1�iSPEC110NS File No. , ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: A dL4 4 Ak4 e /, �L LC l j& C� JJ nn, l Address: D/� 6 Telephone.;�-94?K7�/e/�' 2. Owner of Property: Address: Telephone: 3. Status of Applicant: _Owner Contract Purchaser Lessee Other(explain): 4. Job Location: Parcel Id: Zoning Map# Parcel# e,?t 2 District(s): (TO BE FILLED IN BY THE BUILDING D PARTMENT) 5. Existing Use of Structure/Property h ' f, 6. Description of Proposed UseNVork/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 Permit/Variance/Finding ever been issued for/on the site? NO X DON'T KNOV%' YES IF YES,date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO X 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 �A' 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-2000-0259 APPLICANT/CONTACT PERSON LAFLEUR ARMAND P JR ADDRESS/PHONE 96 LAKE ST 584-7409 PROPERTY LOCATION 96 LAKE ST MAP 17A PARCEL 247 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST , ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid 6& - Tvneof Construction:_ADD BATH IN CELLAR 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 61,01WING 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 Co on 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. 96 LAKE ST BP-2000-0259 G1S#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-247 CITY OF NORTHAMPTON Lot: -001 Permit: Building + Category:renovation BUILDING PERMIT Permit# BP-2000-0259 Project# JS-2000-0403 Est. Cost: $2500.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO Coiist.Class: Contractor: License: Use Group: Lot Size(sa.ft.): 18425.88 Owner: LAFLEUR ARMAND P JR zo,ing:URB Applicant:_ AT.• 96 LAKE ST Applicant Address: Phone: Insurance: ISSUED ON.'o9/o9/1999 o:oo:oo TO PERFORM THE FOLLOWING WORK.-ADD BATH IN CELLAR POST THIS CARD SO IT IS VISIBLE FROM THE STREET Ins pector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Ro ugh: Rough: House# Foundation: Final: Final: Rough Frame: Gas Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Fi ai a l: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: Br, lding 09/09/1999 0:00:00 $50.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo �S HA/f PT City of qo:thampton BUILDING INSPECTION LABEL APPROVE n �spector �� � Date a J, 96 LAKE ST BP-2000-0259 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-247 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:renovation BUILDING PERMIT Permit# BP-2000-0259 Project# JS-2000-0403 Est. Cost:$2500.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Lot Size(sa. ft.): 18425.88 Owner: LAFLEUR ARMAND P JR Zoning:URB Applicant:_ AT. 96 LAKE ST Applicant Address: Phone: Insurance: ISSUED ON.o9/o9/i999 o:oo:oo TO PERFORM THE FOLLOWING WORK.-ADD BATH IN CELLAR 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: /w�t Rougha(J%f!�/y � House# Foundation: Final: Final:1 3/Ud ,� K Rough Frame: .C�G{✓� Gas Fire Department Fireplace/Chimney: i Rough: Oil: Insulation: Final: Smoke: Final:Ok THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATIO OF ANY OF ITt RULES AND REGULATIONS. Certificate f Occupanc nature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 09/09/1999 0:00:00 $50.00 0 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo