23D-156 (4) Department: Reference No: BP-1999-0451
Building, Electrical & Mechanical Permits
Fee Type: Receipt No:
Roofing REC-1999-001201
Paid By: Paid in Full On:
Drew Quinlan Fri Oct 30,1998
Received By: Check No:
Linda Lapointe 181
DEPARTMENT'S COPY Amount: $20.00
DEPARTMENT FILE COPY 150 MAPLEWOOD TERR
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:
30 Oct, 1998 BP-1999-0451 $20.00
GIS #: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
3312 23D 156 001 150 MAPLEWOOD TERR URB 23086.8
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-1999-0871 roofing $600.00
Description of Work:
STRIP & SHINGLE ROOF
GeoTMS®1997 Des Lauriers&Associates,Inc. Signature:
irk
(irli iG� ijU � )
1 OCT 01998 j
3 File NoOy.46
DEPT
°k -ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: Dr eL.J OE, ; k (Oki
Address: /�O A yy%t,o,I / rt_ /14,/ e,yp1-0.,1/*lu Telephone: S Xl, - Za 4/o /
2. Owner of Property: D 1 e--) (;)Li-, k Lif vi
Address: /5 0 �--z aQ/c 0,001 f t/U,r,/4 /'o ,A/1 . Telephone: ,52(-6 1/61
3. Status of Applicant: L7Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: /50 ) -c r-a-s.-•( tie.A.___,
Parcel Id: Zoning Map# a,3� Parcel# .1S3 District(s): CG'vU—
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property 5 i 1 c �cr-,,I/y 1, 0 /,-,
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
-S1,,/9 c-xssA �� fadF sA,,,,�feI/), rr pair 0 Nei f0Iayr-.r,-7-F i h fcdedi
(Perod1 GA./ -ShiI1data /Q /? Jod1- Sit , nj/r5
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 r 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 1/ 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)
10. Do any signs exist on the property? YES NO
Wei
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 column to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - front
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
# of Parking Spaces
# of Loading Docks
Fill:
(volume -& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: /( -_ APPLICANT's SIGNATURE /��7(,(()
NOTE: Issue/aloe of a zoning permit does not relieve an epplioants burden to oompty with ail
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission. Department of Publio Works end other applioable permit granting authorities.
FILE #
ItAM
g�oa��Ta og ^r L5 � U �.:_"..�70[� �t7Z��bI11C�7tIIIi 1 �'t=_�
9%�ih 5�B }ilasaaciissactta =�—' t_
il: orr. 3 0 1998
�' m DEPARTMENT OF BUILDING INSPECTIONS __�`=
. .
. 1)EPI 212 Main Street ' Municipal Building =_
�fI'_i' ^' Northampton, Mass. 01060 ` us'.0_
WORKER'S COMPENSATION INSURA.NCh, AIeFIIDAVIT
1,• rb/ Cw cif, ; , [0V,
(li censec/permi ttec)
with a principal place of business/residence at:
80 Ai r/rrlvrr oi 9-cY_ ./P0/illu07P10h /Ui. o/c(oO (phonei ) Sye (9140 /
(sin/city/staielaip)
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 homeowner(circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Ins-umnc� Comoaily/Poller Number) (Expiration Date)
(Name of Contractor) (lasarance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insura.ncn Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheet ifnorc—ry to'odu&infcrma_ioo pertaining to all coatraer n)
( ) I am a sole proprietor and have no one work ng for me.
(WI am a home owner performing all the work myself.
NOTE:please be awe that w ilo homeowners wtw caaploy persons to do maintru,ner conisructionor repair work on a dwelling of
not mete than throe(mitt in v.-faith the homeowner rcisiacei or era the grounds appurtenant tbceto are Dot generally COW icier d to be
employrr under tbo worker's ooruperutioa Anx(GLI52sa l(5)),application by a homeowner for a liccase or permit may cvidcnce the
legal ctahua of an=cployor under the Worker"'Companatioa Act
I ink-raUnd chit a copy of.thia rzacroomt may bo forward d to the Deputmmd oftInchsstrial Aoadca&Offzoo of tawra000 for tba
cove xge vcrificatioa and that failure to s<xurc covtrago under soetioa 25A of MOL 152 can lead to tba'irrtpo,41ioct of criminal penalties
oomiatin of a-fox up to S 1,SOO.0O and/or impu-aoerncat of tip to one ycnr and civil p eadties in the form of a Stop Work Order and a
fine 1
ne of 5100.00 a day agaimt mc..
•
. ' For L11O only
Permit Number .
*1..-r.. ....:-- .. . . Zf . /O'3O 7� Map# Lot#' f
Signaturi ofLicroscefPermittce late -
�OQ`,ItUMPTO a —
e �
P."`-►� 't � �l .o Z f Northampton EE
�� 1 �O a RSBA[I�1181tt6
_��_
�''7. DEPARTMENT OF BUILDING INSPECTIONS .,, `` ''
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01000 MI"s
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE: ; 0- C_J- 9 2
JOB LOCATION: del 36 /5y' Cc'_—e--
/'� (Map) (Parcel) ( Subdivision)
HOMEOWNER: Dr c,J Cali;n to vt(Name & Address )
/JO yo4 Lv U oc/ }-er, AA-. /4(I.+09 aN - a . S d6, -ID `(O
(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.
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 Azej , Zi,s.jr--
BUILDING PERMIT # ,,
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. '-Y6-6 4-0 l Alterations
?%r NORTHAMPTON, MASS. 19 Additions
. . APPLICATION FOR PERMIT TO ALTER Repair
' Garage
1. Location /SO Ah r�/r 4_10B.01 7`2"r, i1/o r,l?1/. 2, h /Ua, CVO O Lot No.
2. Owner's name Q t rw Qci,nI a N Address / .S a Ai-cif'(c&)ooI 7 r.
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 STr:p rod F sAi-2_5Ir5 trCpc r t!ndeil4( r4/:A1hc-roird, Re too/ w/ EIa dart 3-1'a�-Sh:4r�
13. Siding house
14. Estimated cost:- T6 6d"
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
V ,�a
Signature of responsible applicant
Remarks