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Zoning
Miscellaneous Additions,Repairs,Alterations,etc.- Tel.No.` lvb 0614 Alterations
, > RTHAMPTON, MASS. j� 2 19 Additions
a Repair
APPLICATION FOR PERMIT TO ALTER Garage
Location Lot No.
Owner's nam ess�-2 P�o ud r 1 \
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
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 cosL-
(�00 The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
Sig a ure of responsible app icanl
Remarks'* JS ��
r
Tim
UL im
,,� � JUL 2 � ,
bEPARTMENT OF BUILDIIIG INSPECTIONS
INSPECTOR D a,
i 212 Main Street ' Municipal Building �y
i%l Northampten, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE; � ,�
JOB LOCATION:
(M (Parcel) (Subdivi i )
L-40MEOWNER: 2 P� m( - A �� i2YencPJ Q 062-
`.(Name & Address ) x06(0CiCi q7
(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. q
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.
tff'OMEOWNER SIGNATURE
BUILDING PERMIT #
0� l' ftX of Wart4ampfan
B �
c
_ �xisxcansctta
m DEPARTMENT OF BUILDrNG INSPECTIONS
Ala 212 Main Street Municipal Building
Northampton, Mass_ 01060 y
WORKER'S COMPENSATION INSURANCE AT ' AVIT
Cfcrodd- - "
with a principal place of business/residence at:
-
22- P1 —. J! ._0►��.'�--- bone# � -I
(str /c-ity/statdzip)
do hereby certify, under the pains and penalties of peguly, that:
( ) I am an employer providing the folloNving worker's compensation coverage for my
emplovees working on this job:
(Insurance Company) (Policy Number) (Expiration Dace)
( ) 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:
(ZvTame of Contractor) (LnsZlf-anc,. Company/Poli(7f NI MAhcr) (Expiration Date)
(Name of Contractor) (Insuntncc Compauy(Pohcy Number) (L•xpirauon Date)
(Name of Contractor) (Laauancti Comp-m)-[Policy Number) (E pirabon Dale)
(Name of Contractor) (Iasurmice Comaany/Policy Number) (Expiranon Date)
(atiadr additioml zhcct tfnco=—y to mcb-,&infocrostion pvtaiiung to ell ooclun on)
O I ani a sole proprietor and have no one worling for me.
I am a home owner performing all the work myself.
NOTE_ptcaac be awazc th:t vehilo homeowners svbo cmplQy pc tow to do mxh3j •^*'r 00,tr�or repair wocic oo i dwelling of
not mo"than thrco unit:is which the homoosvocr r=&, ,oo aho U ut appurtcna�ibatto arc oot&coa sly oocn6 cd to be
employrsa under tha wvclec oompe�ea Ad(GL132s31(5))�appticatition by a homeowner for a Gc Wn a permit may evi&ooe the
Itp,ctntut of an omployoc candor tho Wociro z comp'm Lioa Act
I undasiaad that a copy of this rt a,cm may bo forwarded to tbo Dcp"trx of ID&Ld11at A &° &BOO of Im+uzoon for d"
oovcmge va ificatioa and that fi we to secure covcrngo undccr szmoa 23A of MoL 132 caA lead to tbO impozihou of erimival penaitia
00austm of x•Sne'of up to S1,500.00 and/or impri3omncnt of up to 00c year and civil pc a It in the form or
n Stop WorictJtder lad a
fim ofSIOO.Ot7 a day t&inat tw-
°
For.igztmc-w uio oaty
• Pcimit Number
—WO
Y $igi itrc of'Li c ticc
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:
I1. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This C07— to be fl2led is
by the Building Department
I 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)
of Parking Spaces
f of Loading Docks
Fill:
4 vo1-time--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
L16 PLICANT's SIGNATU �
a oe of a zonin b
NOTE: 1 su
g permit does not relieve an applicant's b to comply witft,spit
zoning requirements and obtain all required permits from the Boa alth, Conservation
Commission, Department of Public Works and other applicable permit granting authorities,
FILE #
File No.
DES r~:?F
Iti
ZONING PERMIT APPLICATION (§I0 . 2)
N PLEASE TYPE OR PRINT ALL INFORMATION
L . Name of Applicant:
Address: 2? QivrnouA / yffn(I el Telephone:
2 Owner of Property: ((�� �n
"
Address:7,? A m��lAth Ayc. Telephone: a
Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
V-4+ Job Location: 2-2,
Parcel Id: Zoning Map# 1-1-1d, Parcel# IR District(s): �fC�
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
Existing Use of Structure/Property
Description of Proposed Us ga<(c//Project/Occupation: (Use additional sheets if nece ary):
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_ I oe� 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 L. 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-1999-0123
APPLICANT/CONTACT PERSON Gerald Giguere
ADDRESS/PHONE 22 Plymouth Ave (413)586-6994 O
PROPERTY LOCATION 22 PLYMOUTH AVE
MAP 17C PARCEL 181 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 5
Type of Construction:
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Occupant Statement or License#
3 sets of Plans/Plot Plan
THE F OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
pproved 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
Sgjgjg,_ApprovaI Board of Health Well Water Potability Board of Health
Peii f''lyi 1 W; lk
Or1' tlnlmis5fape„ :..
Signature of Building idf 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.
Reference No: BP-1999-0123
Department: ...................................
Building,Electrical &Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Building- Renovation REC-1999-000200
......................................................................................... ......................................
Paid By: Paid in Full On:
Gerald Giguere Mon Jul 27,1998
......................................................................................... ...........•....•.....................
Received By: Check No:
Linda Lapointe 1888
......................................................................................... ........•.............................
DEPARTMENT'S COPY Amount: $40.00
...........................
J)l`1PARTMEN'l' Fl..LE COPY 22 PLYMOUTH AVE
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-1999-0123 $40.00
GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size:
1811 17C 181 001 22 PLYMOUTH AVE URB 8363.52
Contractor: License Type: Insurance:
Homeowner as Contractor
Address: License No.: Insurance No.:
Liy_i State: Zip Code: Phone:
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0164 alteration-addition $2,000.00
Description of Work:
REPLACE PORCH SUPPORTS,DECKING,& STEPS
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: