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Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. �C��" !J Alterations
NORTHAMPTON, MASS. 46 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location R7 6&a1l b, aaA, Lot No.
2. Owner's name X PMOd A. r��(}�f(���- /,/ t! Address
3. Builder's name mich fu dtfo..- Address o,113z 6&f)d&_
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration FO—)C-(O S t
6. New Porch
7. Is existing building to be demolished?
S. 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#
The undersigned certifies that the above statements are true to the best of his, her
knowled and belief.
d
Signature of re ponsible app icani
Remarks
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Of Stld!VIG"INSPECTIONS DEPARTMENT OF BUILDIXG INSPECTIONS
212 Main Street ' Municipal Building '°+„ sue•
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFMAVIT
j, Sandra Brakey
(licensee/permlttee)
with a principal place of business/residence at'.
343 Glendale Rd (phone#) 586-5893
(st rcWcity/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 working on this job:
(Insurance Company) (Policy Number) (Expiration Date)
(� I am a sole proprietor, general contractor or romeowner ' cle one) and have hired
the contractors listed below who have the following wor e s compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (E)piration 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)
(aaaelt additional sheet if necessary to include information pertaining to all contractors)
( ) I am a sole proprietor and have no one working for me.
(t�I am a home owner performing all the work myself.
NOTE:please be aware that while homeowners who employ persons to do maintenance,construction or repair work on a dwelling of
not more then throe units in which the homeowner resides or on the gro nds appu tanant thereto are not generally considered to be
employers under the workees oompetnatim Act(GL152,ss 1(5)�application by a homeowner for a 6 oe or permit may evidence the
legal status of an employer under the Workers Compensation Act.
I understand ttud a copy of this statement may be forwarded to the Depacrosa t of Industrial Aecideasa'Office of Insurance for the
coverage verification and that failure to secure coverage under section 25A of MGL 152 can lead to the kV0$idi011 of criminal penalties
consisting of a fine of up to 51,500.00 and/or imprisomunt of up to one year and civil penalties in the form of a Stop Work Order and a
fine of 5100.00 a day against me.
Signed this / 14 day of �j 1995 For dcPatmental use only
Permit Number
Map# Lot#
Signature of LicenseeAimittee /
See reverse side for instruetionv
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Y 7 IEPARTMENT OP BUILDING INSPECTIONS
•.-.,.....�_..�1I 212 Alain Street ' Municipal Duilding
INSPECTOR DEPTQF$UfLQ!'',GINSPECTlC1`41S k Northampton, tvtass. OlOGO
HOMEOWNER LICENSE EXEMPTION
��/� � � � ( Please Print )
DATE;
JOB LOCATION:
(Map) ( P reel ) ( S bdivision)
HOMEOWNER:_ f c yZt,
(Name & Address ) n
&b 4ad,
( Home hone) (work Phone
The current exemption for "homeowners" Was extended to include
Owner-occupied Dwellings of one ( 1 )or tti.tn (2) fami 1 ies and to allow suc
homeowner to engage an individual for hire who does not possess
license , provided that the owner acts as supervisor . CMR780 Section 109 .
DEFINITION OF HOMEOWNER: Person( s ) who own a parcel of land c
which he/she resides or intends to reside , on which there is , or i
intended to be , a one Or two family dwelling , attached or detache
structures accessory to such use and/or farm structures . A person wh
constructs more than one home in a two-year period shall not b
considered a homeowner . Such "homeowner" shall submit to the Buildir.
Official , on a form acceptable to the Building Official, that he/sr:
shall be responsible for all such work performed under the buildir
permit .
As acting Construction Supervisor your presence on the job sit
will be required from time to time , during and upon completion of ti:
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 fc
injuries not resulting in Death ) of the Massachusetts General La%
Annotated , you may be liable for person( s ) you hire to perform work fc
you under this permit .
The undersigned "homeowner" certifies and assumes responsibili ,
for compliance with the State Building Code , City of Northamptc
Ordinances , State and Local Zoning Laws , and State of Massachuset:
General Laws Annotated .
HOMEOWNER SIGNATURE J'
BUILDING PERMIT t
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 color= to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks -
i
side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paired parkingN
# of Parking Spaces
f '6f Loading Docks
Fill:
4 vol-dme--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowle qe.
_1 j
DATE: 5-/5- 97 APPLICANT's SIGNATURE /}
NOTE: Isauanoe of a zoning
� permit does not relieve an applioanYs bu den to pFy witF1,.$11
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 #
=_j
File No./ V � i
DEPT OF BUILDING INSPECTIONS
4dORTHRid�T�a�� F.� �...
wr ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:��)Q°f)('�12C. l�( �t 1
Address: .. 3 Cten,01& , Picid Telephone:_ �� �1' �%✓
2. Owner of Property: /t.C� , ' I /
Address: 5Y3 &Pl 0 l,I;& ;a d, Telephone: ,6 2(o -5 U3
3. Status of Applicant: ✓ Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: 3YJ C(Zh(' (7_& .&ax d-,
Parcel Id: Zoning Map# Parcel# Q District(s): a/\
(TO BE D IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property /bea /0 /-/—/
6. DescriInption of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
c I '
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 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)
FILE #
LDR1W554RH MANWIC t ACT PERSON:
E:
DEPT OF sUn w4c;INSPEG I
PROPERTY LOCATION:
MAP PARCEL: e9 ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERK UT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM EITLED OITT
Fee PAid
IRnildin2 Permit Filled mit
q —
Ad(fitinn to Existing O'-
TEFF^LLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
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
t fr on
�G
Signature of Building ector Date
NOTE:issuance of to zoning permit does not relieve an applicant's burden to oompty with all
_ zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
t
p�° -may City of Northampton REQUIRED INSPECTIONS
! 1. Footings and Walls
• e BUILDING DEPARTMENT 2. Structural Components in Place*
a
3. Complete Building*
No. 404 Office of the Building Inspector
Zoning Form No. 962251 Date 5/16/97 Fee$40.00 Check# 3813
Page, 49 Parcel 20 ,Zone SR Section 127 ❑ Yes 0 No
BUI]LDINGPERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Sandra Brakey before Building Inspections
has permission to screen in existing 10' X 12' deck Inspection on Site—Foundations
situated on 343 Glendale Rd 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 on file in this office, and to the Gas Inspection
provisions of the Statutes and the Ordinances relating to the Construction,
Maintenance and Inspection of Buildings in the City of Northampton. Inspection of Wiring—Rough
Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring—Finish
of this permit.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
Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON TIJY PREMISES
Certificate of Occupancy
Building Inspector
MORTGAGE LOAN INSPECW ON
I'HiS PLAT IS POR [DENTiFiCA1ION I'Util'OSIiS ONLY AND DOES N I'CONS'i'I"i'EJi'L A "I Y SEJ11;
r 'aid
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J4_3 G L ENl 1DAL E PC /A /D
TO 11 I FLORENCE SAVINGS BANK AND "i'm FIRST AMERICAN TITLE INS. CO.-ONLY
To the Kest of my knowledge,information andbelief,I hereby report that i have exa mined tile premisesand that Ibis inspection flat slrowsthe
improvement or improvements as located on the premises described,that the improvement or improvements are entirely within lot lines,that
there are no encroachments upon the premises described by the improvement or improvements of any adjoining premises,and that there are
no easements of record affecting the tract shown hereon,except as shown.
vl►``A`lH Oi
i further report that the premises shown on this plan is not located within a Flood Hazard Area as shown o o� PAUL y°�+
Department of I E.U.D.Federal Insurance Administration Maps, A.
LUSSIER N
Communil Number 250167 0001A ` No. 29648
y APRIL 3, 1978 �*1 ISi��, S�Q�
Identification Date OpAt LAND
P.LS.
HUNTLEY OWNER LEONARD A. & SANDRA D. BRAKEY
ALAIER IIUNTLEY, JR. & ASSOCIATES, INC.
Surveyors - Engineers - LandscapeArchilects
LOCA'T'ION 343 GLrNDALE ROAD NORTHAMPTON
30 Industrial Drive East
Northampton,MA 01061 � n '
1?0tcc'(413)58.1-74144 fax(413)586-9159 Joi3 No. �� i�7 DA"113 /13/9 scnLr: _