18D-053 •
80 DAMON RD BP-1999-0615
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Bloc13D-053 CITY OF NORTHAMPTON
Lot: -199
Permit: Building
Category:Non structural interior renovations BUILDING PERM IT
Permit# BP-1999-0615
Project# JS-1999-1172
Est.Cost: $1500.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): Owner: Jacquelyn Martinez
Zoning: GI/WP Applicant: Homeowner ntractor
AT: 80 DAMON RD
Applicant Address: one: Insurance:
ISSUED ON:O1/06/1999
TO PERFORM THE FOLLOWING WORK:REPLACE 1/2 BATH W/LAUNDRY FAC
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: Rough: House# Foundation:
Final: Final:
Rough Frame:
Gas Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: 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:
Building 01/05/1999 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
File#BP-1999-0615
APPLICANT/CONTACT PERSON JACQUELYN MARTINEZ
ADDRESS/PHONE 584-9092
PROPERTY LOCATION 80 DAMON RD-#8111
MAP 18D PARCEL 053 ZONE GI/WP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOS$D REQUIRED DATE
ZONING FORM FILLED OUT //
Fee Paid
Building Permit Filed out
Fee Paid �, 7 .j
7,0
Typeof Construction: REPLACE 1/2 BATH W/LAUNDRY FAC_
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildin Plans Included:
/Statement or License .�
3 sets of Plans/Plot Plan
THE F LOWING 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
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Consery 'on ommission
97
Signatur o Building i 1 Date j
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.
J � +r.� [ � dC �, '`.
L al 41999 Fileg�
No. �I
DEFT OF BU ^T'"
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: Jfr UC j JL/, e Z
Address:r0� m0/! 6/1.d 141i7/ (P/// Telephone: 57V-94'9.
2. Owner of Property: Jet e'" 'rJA('q/eU7/n 1047'`/7GZ
Address: el°van904 id aef-77i Telephone: SW 9D 9 2
3. Status of Applicant: A Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: UQ.YII 'L
Parcel Id: Zoning Map# gi) Parcel# 3 D trict(s): P
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property O2r /cVsarkle /'tS'i oinccP
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): •
/e,/n'vir�al A srr7q//i�, i '`//J 4//i/g /aUIT
�/ O o
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 X.
\ 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 X_
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
IF YES,describe size,type and location: (JO!?0/0 CONw4X r/ GtTP/! "►{ "
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 - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&p?coed parking)
# of Parking Spaces
# fof Loading Docks
Fill:
-(volume -& location)
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
DATE: —y fY APPLICANT'S SIGNATURE ( iv!j��
NOTE: Issuanoe of a zoning permit does not relieve an ppl" ant' urden to oon�idty with aR11
zoning requirements end obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appiioabie permit granting authorities.
FILE #
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DEPT OF 8U PECTIONS
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`�"�' ' ' DEPARTMENT OF BUILDING INSPECTIONS __'`=
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INSPECTOR 212 Main Street ' Municipal Building
- v Northampton, Mass. 01060 _'`'
'
HOMEOWNER LICENSE EXEMPTION
( Please Print)
DATE: /'V-97
JOB LOCATION: /S U '3 4) P
// J �
Map) (Parcel) (Subdivision)
HOMEOWNER: JGlr/Cr o' ,,✓e s7 4/'h/7 7 trD .)amfriDr!/e0/Cdrr�amJ'/8///
�/ (Name & Address )
J��r fib n,V,2 .52P'5 y09oZ _57. s-r
(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
r 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
BUILDING PERMIT # r,
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DEPARTMENT OP BUILDING INSPECTIONS __I_i-
• DEPT OF 8i _412 Main Street • Municipal Building 'o =
Northampton, Mass. 01060 UP"�sy
WORKER'S COMP
4/i ENSATION INSURANCE AFFIDAVIT
I, tier" oar 4, e e
(hcensec/permittee)
with a principal place of businessresiden at:
(OD/rno/7 1aI&i70o 2n,J E///. , 41,04^fA17 (phone#) 57 y 9a9 .2
(bti eet/clty/stafr/up)
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) (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 if necessary to 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 persons to do ins lotPn.oe,-,construction or repair work on a dwelling of
not more than three units in which the homeowner resides or on the grounds appurtenant thereto are not generally ooaridered to be
employers under the worker's oompeasation Act(GL152,ea 1(5)),application by a homeowner for a license or permit may evidence the
legal status of an employer under the Worker's Compensation Act_
I understand that a copy of this statement may be forwarded to the Dep armrrot of Industrial Accidents'Office of Insurance for the
coverage verification and that failure to secure coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties
oomisting of a fine of up to S1,500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine 0(5100.00 a day against me.
For departmental use only
Permit Number
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc.iikrccr"%r Tel.No. g Alterations
NORTHAMPTON, MASS. /'— (% ' / ]g Additions
,) APPLICATION FOR PERMIT TO ALTER Repair
..i-�" D Garage
I. Location o Da��� �� C/10o Ui7;21 ei,/ C ` ) Lot No.
2. Owner's name JAt/iec *-lAe}ic ribr71-ii/"Z Address s-e.)L rro,I,eci 5d7//
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition 'l L
5. Alteration /r"✓-nOvi hethc '`, ,r,viri//j/�G� /ilt�/lo/iy24c.//es'
6. New Porch d1(l d t/
7. Is existing building to be demolished? J4 6
8. Repair after the fire /<7 0
9. Garage 14 0 // No.of cars Size
10. Method of heating a%'T
11. Distance to lot lines —
12. Type of roof
13. Siding house br/CA/v,n1)
14. Estimated cost-
4/3 Z9
The undersigned certifies that the above statements are true to the best of his, hr
knowledge and belief.
1-71Y4 --4'.
Signature of responsibe appicant
Remarks