Loading...
23D-064 (16) Department: Reference No: BP-1999-0083 Building, Electrical & Mechanical Permits Fee Type: Receipt No: Building- Renovation REC-1.999-0001.35 Paid By: Paid in Full On: Marjorie Tetrault Thu Jul 23,1998 Received By: Check No: Linda Lapointe 425 DEPARTMENT'S COPY Amount: $84.00 DEPARTMENT FILE COPY 40 NUTTING 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-1999-0083 $84.00 GIS#: Map Block: Lot: Address: Zoning: Use Group: Lot Size: 3223 23D 064 001 40 NUTTING AVE URB 12980.88 Contractor: License Type: Insurance: Homeowner as Contractor Address: License No.: Insurance No.: City: State: Zip Code: Phone: Project No: Category of Work: Const. Class: Cost Estimate: JS-1999-0119 Building $14,600.00 Description of Work: 10' X 15' att breezeway with 2 car garage 7 Des Lauriers&Associates, Inc. Signature: File#BP-1999-0083 APPLICANT/CONTACT PERSON Marjorie Tetrault ADDRESS/PHONE 40 Nutting Avenue (413)584-6440 0 PROPERTY LOCATION 40 NUTTING AVE MAP 23D PARCEL 064 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 17615- t/ZI{ +/ Type of Construction: New Construction Jo ")C I S" Non Structural interior renovations GJ / y ' 3 C' cat- Addition to Existing Accessory Structure Building Plans Included: ✓ Owner/Occupant Statement or License# 3 sets of Plans/Plot Plan 1./ THE FfdLLOWING 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 sion '°;.-'--;' _'°.-,,--- 2 fe5 Signature of Building Official Dat 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. 51) Liu JUL 2 3 i938 '\ DEPT OF BUILDING INSPECTIONS File No.&P_ Q 99_v - NORTHAMPTON MA 01060 ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: ///`( ri e I e Address: 11-0 /Y UI4 Telephone: ,_5 -loiZv 2. Owner of Property: /6/4-9f !?j 07 Address: 51101k1 Telephone: / -D44. ` a 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): ______� 4. Job Location: " (r0 Alt,L7( r11 , _ I ha N Parcel Id: Zoning Map# A) Parcel# 6 7 District(s): ,(.�(,--' (TO BE FILLED IN BY THE BUILDING DEPARTMENT 5. Existing Use of Structure/Property ,S r/7 6. DeMhi\ of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): Q'10XIc�Br zCT,lal \Ai Aatizi151 CAP•Cj-ArAy 7. Attached Plans: V 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 PermitNariance/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 DONT KNOW 7 YES IF YES: enter Book Page and/or Document# 9. Does the site contain a brook, body of water or wetlands? NO V 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) —NOTE- -- THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT • = •. TRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED. j N T [E 0 d f; BUILDING LOCATION ACCURACY IS NOT GUARANTEED JUL2 3 `����• � 1 +/ . _.:i. -- - ic.-..._:-.------- ----- • _ N = 0 oii ► a 4 40 Nutting Avenue _ �' ;- Northampton, MA 01060 " * ° ;}, IG.d4 '{ \A .92, '-i. !o.9o'A t' • t- . -- a� ` 'sue, \4 4 , , ,, , \9 I. _71� • �, c. `i yo' t� y. ._t 1 30 �-i� �o a�/ l5 r \ aQl AUL, 0 / I i _II ,, �a'1 N l�O.pp"z ril P0: FLORENCE SAVINGS BANK & FIRST AMERICAN TITLE INSURANCE COMPANY TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES, EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR COMMUNITY # 250167 -NOTE- SURVEYOR: . � THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY AND DOES NOT CONSTITUTE A PROPERTY SURVEY 101, OF "++sue -MORTGAGE LOAN INSPECTION PLAT- sic tick ., NORTHAMPTON, MASSACHUSETTS RANDAL1 0 E. PREPARED FOR U H WENDY B. ORTIZ & JOANNE F. NADOLNY l3500332 �� 32 SCALE: 1 "=40 ' SEPTEMBER 25 , 1997 0 suRVEN°lat HAROLD L. EATON AND ASSOCIATES, INC. REGISTERED PROFESSIONAL LAND SURVEYORS 235 RUSSELL STREET - HADLEY - MASSACHUSETTs 8K4349PG0020 029690 WE, GERALD BRACHMAN and WAYNE BRACHMAN of Northampton, Hampshire County, Ma' ache tts, being unmarried,for the full consideration of THIRTY THOUSAND ($30,000.00) DOLLARS paid grant to WENDY B. ORTIZ, of 726 Meadowbrook Apartments, Northanptcvt, MA; and JOANNE F. NADOLNYr R s 7s , of 39 Fact Green Street, Easthanptc.n, MA with tnarrantg robnu,nts the hied in Northampton, Hampshire County, Massachusetts situated on the southern side of Lonsdale Street designated as Lot A on a plan of land entitled "Plan of Land in Northampton, Massachusett a Prepared for Virginia M. Flynn", dated September 11, 1985 by Almer Huntley, Jr. & Associates, Inc. which plan is recorded in Hampshire County Registry of Deeds Plan Book 140, Page 19, the said premises Q rn . being bounded and described as follows: a Beginning at an iron pin in the southern line of Lonsdale Street ▪ c which iron pin marks the Northeastern corner of the premises being a ° conveyed; thence z a E • m S. 33 59' 42" E. a distance of Seventy-Five and Ninety-Six One Hundredths (75.96) feet to an iron pin; thence a� u Z S. 58 12' 12" W. a distance of Ten and Ninety One Hundredths (10.90) feet to an iron pin; thence S. 33 20' 00" E. a distance of Six and Four One Hundredths (6.04) 'o feet to an iron pin; thence S. 57 40' 40" W. a distance of One Hundred Forty-Eight and Ninety- Eight One Hundredths (148.98) feet to an iron pin; thence I- N. 34 03' 06" W. a distance of Seven and Forty-One One Hundredths (7.41) feet to an iron pin; thence N. 34 03' 06" W. a distance of Seventy-Three and Fifty-Nine One Hundredths (73.59) feet to an iron pin; thence N. 57 21' 17" E. a distance of Eighty (80.0G) feet to an iron pin; thence N. 57 21' 17" E. a distance of Eighty (80.00) fee to 'the iron pin at the pont of beginning. The last two courses being along said Lonsdale Street. Containing 12,960 square feet, more or less. BEING the same premises conveyed to the Grantors herein by Deed of Virginia M. Flynn, dated September 4, 1986 and recorded in the Hampshire County Registry of Deeds in Book 2801. Paae 206. FRONT VIEW CUSTOMER -- ; ; ; DATE 04/01/98 REF JARVIS q ,ii, I\ ' \' i \ ♦ 1k4\4;\ I �11 . ' `%i 1111,I%1' II• p,\11j1 ,i \. II I II II 1' I • •� � „ ' I N I .' ` r � � II%o�l lIV i � �I I r � � ` �, t-ii . - . 'W4iii*--4---'-',-,1-tyl 14 ill%II-6-111 iiii ' \k-'"'-‘4,,N, 4*--A0 I I ,../ / . I11 ez • _ IIII I ' RUGG LUMBER CO 24 W. STREET W. HATFIELD, IAA a .S (711;:iidSNI 911:"1111E JO 1d30 sus} E Z l(lf REAR VIEW CUSTOMER DATE 04/01/98 REF JARVIS /I ► �i/1/II/11/P/,II///I/II/I111'I/I/' ,,ilk N 0 N \'` /•/'I/I// ///I I/ II, II/ II;-/►j,. ,. I I: II 11 1%,/II I/ II II II /I` .��%. ��C. h I�4/I/,diI/./ r II/ I/ II. I�/- I ►i. �'�.� j,P/II�II// /� ' rI� I• I' �I II I �. r 1 // // �'er -// / - /v/_ II/d/'III//'//I/1/I II .II„7 +•a� .. ���/ � —.of // -i • ///•I/ a '11 . / 0 ,.,..- % !, ice. ,,/I//I, I,, ,I .i= /"/-,,dr;;,7".07>-.0,,,".<:0+,4 0'I 4,I[#j ''lir 1,"" I jogoi 1::_.::.:__: ...z.,-:-,.: i.141:1'it iii iiiii it rt....7.,tillt.._.,.7,t_.%,,,,,..,: h44441,14pprior/e7.4, 7,,,,,,- ---A":41",/.,. /M,r;I..i '- . ' IItilij I, � /� � /j A :J., i,s , N J 'N I l RUDD LUMBER 00 24 W. STREET W. HATFIELD, VA • a PLAN VIEW RUGG LUMBER CO CUSTOMER -- ; ; ; 24 W. STREET DATE 04/01/98 REF JARVIS W. HATFIELD, MA 25' 5'8' 2' 8' 9'7 1/4' 3' 1 i/2' 3'11 1/4" I m N ci h 2'10 1/2' 9' 1 1/2' 1' 9' 1 1/2' 2' 10 1/2' ROOF: You selected a 8/12 pitch, 12 " eave overhang, 0 " gable overhang and Rafter construction. WALLS: You selected a 8' wall height and 12 " foundation height. NOTE: The suggested design is not for an attached garage, nor is the garage intended to be inhabited. The suggested design is not a finished building plan. You are responsible for all measurements being correct, for verifying that the design (and any substitutions or modifications that you make) meets all local building codes and requirements. To verify that the suggested design, and any substitutions .or modifications, is consistent with conditions at the construction site, review the design with your architect. Also consult your architect for proper construction and use of materials in the structure. Be sure to follow the garage construction detail available from your store salesperson. RUGG LUMBER COMPANY PAGE NO 1 HAMPSHIRE DIVISION RUGGWEST 24 WEST HATFIE!D, MAET01088 PHONE: (413) 247-8300 THANK YOU FOR SHOPPING RUGG LUMBER! CUSTOMER NO. JOB NO; PURCHASE ORDER NO, REFERENCE TERMS CLERK DATE TIME *6 CASH PAT 4/ 1/98 3:12 J **** CASH **** S MIKE JARVIS EXP. DATE: 4/ 8/93 DOC# 239848 1 584-4040 EXT 2224 #**#*#******* P * ESTIMATE * T SLSPR: 55 RICH B ************* \. TAX : 001 MASS SALES TAX EST. 239848 QUANTITY SHIPPED ORDERED UM SKU DESCRIPTION LOCATION UNITS PRICE/PER EXTENSION 1 1 EA D8550 1/4"X5-1/2" FOAM SILL SEAL 50' 2760 EA 2612PT 2X6X12 #2 .4000A PT SYP 266 EA 2412 2X4X12 STANDARD & BTR KD SPF 263 EA 2408 2X4X8 KD SPF STUD 263 EA 21220 2X12X20 #2 &BTR KD SPF LONG EA 21216 2X12X16 #2 &BTR KD SPF 264 EA 21016 2X10X16 #2 &BTR KD SPF 263 LF 16PWP 1X6 PREMIUM & DTR. WHITE PINE/LF 260B 11/12.00 EA S008 25'REG TRUSS 8/12 PITCH 12"OH 2 EA S008 25'GABLE TRUSS 8/12 PITCH 12"OH 2 EA 38UI.0 1. 3/8"X4X8 FIR PLYWOOD UNDERLAY 265 EA 12CDX 415/32"X4X8 CDX FIR PLYWOOD 265 EA 58CDX 9S19/32"X4X8 CDX FIR PLY SHEATHING 265 EA WSBK -'BIRD WINDSEAL BLACK BLEND 256 EA FELT ✓4 SQR ROLL #15 FELT MULTIPURPOSE 257 EA RV20 / RIDGE VENT, 20' COBRA 278H EA 114GR50 150# 1-1/4" E G ROOF N317 EA 5ADE10 \/DRIP EDGE, 5"X10' ALUMINUM 280D GA 2056"" 14 P4y cITTI 4-4/IE. LILT CI11 IS I ?1711 CONT'D ( RECEIVED BY RUGG LUMBER COMPANY PAGE NO 2 HAMPSHIRE DIVISION RUGG 24 WEST STREET WEST HATFIELD, MA 01088 PHONE: . 413) 247-8300 THANK YOU FOR SHOPPING R1J30 LUMBER! CUSTOMER NO JOB NO. PURCHASE ORDER NO. REFERENCE(' TERMS CLERK DATE TIME 1 *b CASH PAT 4/ 1/98 3:12 (S **** CASH **** S MIKE JARVIS EXP. DATE: 4/ 8/98 DOC# 239848 4 W L o4C 1584-4040 EXT 2224 D T * ESTIMATE * 0 ' . _ 0 SLSPR: 55 RICH B ************ TAX : 001 MASS SALES TAX EST. 239848 QUANTITY 3, SHIPPED "' ORDERED UM SKU DESCRIPTION I fd'ATTfIN UNITS PRICE/PER l EXTENSION EA 239054 HWI ENTRY LOCKSET 220B5 1 EA SILVERLINE V 32"X38" WHITE VINYL DH SERIES 2 4000,WINDOW WITH REG IG GLASS, NAILING FIN,WLF SREEN EA 16COM50 50# 16D COMMON N324 EA 1000M50 50# 10D COMMON N327 EA 8C0M5 5# BD COMMON 211F3 TAXABLE 3411.00 NON-TAXABLE 0.00 X ** ESTIMATE ** ESTIMATE ** ESTIMATE ** ESTIMATE ** SUBTOTAL 3411.00 RECEIVED BY TAX AMOUNT 170.55 TOTAL AMOUNT 3581.55 �^ 1 / /7 ? › I .1/4..._ ..______ 1 .1avp E-' . ki $ - groputm x19S st,t vo p Jro 19 3 r sa Fu 1 4s +.iro'O sli ftl "/grd u1 sass 0,i j 1 w x �� ` d- 4. '?InstAb altocfb chap 4()1.7 h- ki wo 15J arrp S /m u i 1°a)1 `-i- 'rioucr, uoi. ppu7,oa. oi$ ti g-I'7ua7 ut s 91 000c75 54oFI 411 _,0 51211 +1-1-Q -4/ G/1/115153 i(- 2l 17 p" ,„ 4:2St'7/9 /7(;zsAy -. Qao 'v' 7. ,J�'9, Vi --• File No. UVib9/-3.392 arty Address 40 Nutting Avenue city Northampton State MA Zip Code 01060 . legal Description Book 4349 Page 2_0_Hampshire County Registry County Hampshire Assessor's Parcel No. 23D/64 Tax Year 97 R.E.Taxes$ 1,629.31 Special Assessments sNone p/ w Borrower Mar'orie Tetrault Current Owner Ortiz & Nadoln Occupant I X(Owner [ ]Tenant I (Vacant ��'�—� Propert rights appraised X SimpleType PUD 1 (Condominium(HUDNA only) HOA SN/A /Mo. f --"t , y g Fee Leasehold Project r.._ u7 Neigh orhood or Project Name None Map Reference See Attached Census Tract 8216.02 Saks rice 8104,000 Date of Sale Pending Description and 8 amount of loan charges/concessions to be paid by selleRNOne AQ :;end /Client Florence Savings Bank Address 85 Main Street, Florence, MA 01062 Appr ser Karl Robert Heston Address Northampton Appraisal Associates, Northampton MA ci �Loce on u Urban X Suburban Rural Predominant Single family housing Present land use% Land use change M Built p u Over 75% 25-75% Under 25% occupancy $1000) ,���, One family 80 (X(Not likely nlikely �� �f Gro h rate Rapid n Stable Slow X Owner 70 Low 3 2-4 family 20 nin process �/ Prop y values Increasing n Stable Declining Tenant 250 High 150 Multi-family To: -Dam nd/supply Shortage In balance Over supply �{ Vacant(0-5%)' Predominant 7 Commercial �� 'M9p ting time Under 3 mos.n 3-6 mos. El Over6 mos. uveeenr lover s%i 120 50 ( ) 0'a Race end the racial composition of the neighborhood are not appraisal factors. "'eig borhood boundaries and characteristics: See Addendum #1 c r 0 8 i ' s that effect the marketability of the properties In the neighborhood (proximity to employment and amenities,employment stability, appeal to market, etc.): ix m The subject property is located in an area of similar single family residences zoned for residential use. The subject is less than two miles from the center Z of Northampton for shopping, employment and public transportation. Schools are an average distance from the subject neighborhood and highway access is convenient. Market conditions In the subject neighborhood(including support for the above conclusions related to the trend of property values,demand/supply,and marketing time - - such as data on competitive properties for sale in the neighborhood, description of the prevalence of sales and financing concessions, etc.): See Addendum #2 etProject Information for PUDs(If applicable)--Is the developer/builder In control of the Home Owners'Association(HOAl2 0 Yes o No a Approximate total number of units in the subject project N/A . Approximate total number of units for sale in the subject project_ N/A . Describe common elements and recreational facilities:N/A Dimensions See deed attached Topography Mostly level Site area .30 Acres Corner Lot Q Yes p No Size Typical for Area Specific zoning classification and description Residential URB Shape Irregular Zoning compliance M Legal ElLegal nonconforming lGrsndfathered((Rai I ,Illegal n No zoning Drainage Appears Adequate Highest&best use as improved n Present use n Other use(explain) View Typical Utilities Public Other Off-sits Improvements Type Public Private Landscaping Average tW— Electricity © Street © Gravel io Breakers Asphalt Driveway Surface Gas © Curb/Gutter Asphalt © Apparent Easements See Below Water © Sidewalk None II. FEMA Special Flood Hazard Area n Yes I X(No Sanitary Sewer© Street Lights Yes © FEMA Zone C Map Date_April 78 _ Storm Sewer © Alley None 1.11 FEMA Map No.250167-0002A Comments(apparent adverse easements,encroachments,special assessments,slide areas,illegal or legal nonconforming zoning use,etc.): No apparent encroachments or adverse conditions. Please reference Deed recorded and attached f r easements and rest ictions of recor . GENERAL DESCRIPTION EXTERIOR DESCRIPTION FOUNDATION BASEMENT INSULATION No.of Units One Foundation Concrete Slab NO a Area Sq.Ft. 960 Roof u No.of Stories One Exterior Walls Vinyl Crawl Space None %Finished None Ceiling (l---l1 • Type(Det./Att,) DetachRoof Surface As a t Basement 100 Ceiling N/A Walls I I Design(Style) RanchGutters&Dwnspts.JeS Sump Pump No a Walls N/A Floor L�„5J Existing/Proposed t Window Type bl—Hun Dampness O e Floor N/A None I I r Age(Yrs.) 3 Storm/Screens he Settlement NO a Outside Entry Yes Unknown I X I z L Effective Age(Yrs.) Manufactured House N Infestation None ulk he d j ROOMS Foyer Living Dining Kitchen Den Family Rm, Rec.Rm. Bedrooms #Baths Laundry Other Area Sq.Ft. aBasement 960 M Level 1 1 Area 1 3 1 960 LL p Level 2 z — O u Finished area above grade contains: 5 Rooms; 3 Bedroom(s); 1 Bath(sl; 960 Square Feet of Gross Living Area a INTERIOR Materials/Condition HEATING KITCHEN EQUIP. ATTIC AMENITIES - CAR STORAGE: `o El l • Type FHA Refrigerator I X None n Fireplace(s)# n None Ct Walls D a 1 Fuel Gas Range/Oven X Stairs n Patio E Garage #of cars Trim/Finish Pine Condition Avg/Good Disposal Drop Stair n Deck Attached Bath Floor Vinyl COOLING Dishwasher Q Scuttle n Porch n Detached Bath Wainscot Fiber lass Central None Fan/Hood ( I Floor Q Fence E Built-In DoorsHollow Other None Microwave Heated II—',I Pool n Carport _All in Ave/Good Cond. Condition N/A Washer/Dryer u~ Finished - Driveway Ample Additional features(special energy efficient Items,etc.):See Addendum #3 rn Condition of the Improvements,depreciation(physical,functional.and external),repairs needed,quality of construction,remodeling/additions,etc.:The w subject is in average/good condition, and displays deferred maintenance • typical for a property of its effective age. No functional, external or locational inadequacies were noted, and the subject could be occupied as is. Lk Adverse environmental conditions(such as,but not limited to,hazardous wastes,toxic substances,etc.)present in the improvements,on the site, or in the Immediate vicinity of the subject property: No unusual environmental characteristics were noted. addle Mac Form 70 0-93 TIns form wee reproduced by United Systems Software Company 18001 969.8727-Pao,1 Fannie Mae Form 1000 0.93 • a z o S d -_ o er.z9:,.,o-f,.zif-.-...-.-_---:-m--.-c7§.---_‘)-i-,/--iL,.ie zv,)_;,,-..,'.. m cx&7>ztr:1;i Wn." r I z' m t t i n 3 71 NL9 (:- 2, — rri \ \ 0 7 aj s a _ W Q ihT N Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations . ( %r NORTHAMPTON, MASS. 19 Additions APPLICATION FOR PERMIT TO ALTER Repair -:-�' Garage 1. Location h Lot No. 2. Owner's name Address 0 t 3. Builder's name Address 0 i Mass.Construction Supery 's License No. Expiration Date 4. Addition ( Ct4e kt`in X 3© 5. Alteration 6. New Porch Jo )( 13 0 pe1') 7. Is existing building to be demolished? / I () 8. Repair after the fire AM 2 9. Garage ii.... No.of cars a_ Size a K 3 0 10. Method of heating y1 kg Vid 11. Distance to lot lines 12. Type of roof `0)kkettill°4 --- Or•J`ki. 13. Siding house ,,��,,11 14. Estimated cost:- /y ) 6 W The undersigned certifies that the above statements are true to the best of his, her knowledge and belief. Signature of responsible oppiicant Remarks .I Door I I 14144 3341‘ volvA Fbo+tn S 8X110 s� ...on I3008 S Li') concittfket f 10 > , i , , :1- ,c,K.. 3900psi Val w +ft ctr2te lockft.tpc,„(L, 01.x4- v Caylar. trce2 \ ,'e 30 r ccArkgLti- skuviee a14 \ a x 9 ' 1 QA.igt-ede' d co rs ,i, d d� 36x5 up ctn do (Asa_o___L _ flovSE pf / '/ t t do o►^s ,pre.kivil . '--.7 ;0' on(tow) I I I y' ? 1 SNGiN Gr t .G$g id3a � lEzinr V k r • '_41 « . SO (2 , LZ' 46 41.fiLl . A., _ ;; k (!I'i4r of Northampton ► -##= / 4 0 a,7 j nesacitusetle =£� �'— tW DEPARTMENT OF BUILDING INSPECTIONS 472arg INSPECTOR 212 Main Street ' Municipal Building 'a,N— Northampton, Mass. 01060 II.' HOMEOWNER LICENSE EXEMPTION G (Please Print) DATE: 90 JOB LOCATION: O /Vat`J doe-- n„� (Map P ce ( Subdivision) HOMEOWNER: /�/ It& �j �/ �// // A _ �Na'"We�� f�`/yf �i -0( ,t56 o1Y� :�� y4 (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 ac 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. 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. 4.:(4rii_ _.4 ),;(-AfieJK72 HOMEOWNER SIGNATURE BUILDING PERMIT it . • 9 A ,cF a» �9 Gx ° o t1 �I111�J II11 1 #* `.arm 1. y Ra j^: li _�_ ;__ B f=` +�► �Z6 Alassucflnsctts '_ gst. ,� _-�• — �a } DEPARTMENT OP BUILDING INSPECTIONS d . 212 Main Street ' Municipal Building Northampton, Mass. 01060 1-277.117.D.I_L------7, WORKER'S COMPENSATION INSURANCE AFI.4'.WAVIT 0 (licensec/permittee) with a princip lace of business/residence at: / !/ dT , hone#) 5O't'—Co wo hinv do hereby certify, under the pains and penalties of per3tuy, that: a up ( ) 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 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) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional sheet ifne, .ryto include information pertaining to all contractors) ( ) 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 while homeowners who employ persona to do mainimm n construction or repair work on a dwelling of not mot,than throe units in which the homeowner resides or on the grounds appurtenant thereto arc not generally considered to be employers under the worker's oala mica Act(GL152,ss 1(5)),application by a homeowner for a license oc permit may evidcooe the legal status of an employer under the Worker's Compensation Act. I understand that a copy of this statcmcat may be forwarded to the D taxnt of Industrial Accidents'Office of Insurance for the coverage verification end that failure to secure coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties consisting of a fine of up to S 1,500.00 andlor imprison of up to one year and civil petnities in the form of a Stop Work Order and a fine of S 100.00 a day against tee. ,J 1 For d uo only 441 /Audi- Pe• rmit Number A, Map# Lot#t Signature I LiaaseefPermittcc Late tl rwx': M•a_ f