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Miscellaneous Additions, Repairs, Alterations, etc. Tel. No. � - 1 11 1 � Alterations
%r. NORTHAMPTON, MASS. 19 Additions
F A' ' APPLICATION FOR PERMIT TO ALTER Repair
4 " Garage
1. Location ( LEkL ) re 1 c> Lot No.
2. Owner's name �'i< { i) L 1 14-k Address Lt O'` Ot:A., 4 A
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 Iw i, , _ '_'`_ • f
13. Siding house
14. Estimated cost:-
1 �
1 \ The undersigned certifies that the above statements are true to the best of his, her
(,) knowledge 40 • - lief.
, Sir , vi,..„6 - ccrtt & ses._ ° , -
Signature of responsible appicant
Remarks
4TNAMpi. - .
a �� $ 6±0 of Norfliantptun ► _
$ ��� �r % BY .lasaac1rnsctt —
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1199 =w—
DEPARTMENT OF BUILDITjG INSPECTIONS 4 _ ! i=
"'P Of ' 212 Main Street • Municipal Building "' y
Northampton, Mass. 01060 es
WORKER'S COMPENSATION INSURANCE A.FFWAVIT
(licenseelpermittee)
with a principal place of business/residence at:
l.. a peso 1,v tr"\ J (p hone #) gq,....
' 1
(s treet/ci ty /statehi p )
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 ifneoensary to include information pertaining to all coat:radon)
b A 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 maintenance, construction or repair work on a dwelling of
not more than three units in which the homeowner resides or on the grounds appurtenant thereto arc not generally considered to be
employers under the worker's compensation Act (GL152,ss 1(5)), application by a homeowner for a license or permit may evidence the
legal status of an employer under the Woeket's Compensation Ace.
1 understand that a copy of this stateenent may be forwarded to the Department of Industrial Accidents' OISoo of Insurance for the
coverage verification and that failure to secure coverage under section 25A of MOL 152 can had to the imposition of criminal penalties
oomisting of a fine of up to S1,500.00 and/or imprisonment of up to ow year and civil prssal in the form of a Stop Work. Order and a
fins 0( 5100.00 a day against me.
Signed this .Z_day of 199 7 For departmental user
Permit N
■ 4 . ' / ,f sue_ * 40 "f � _� _ Ma
p# Lot # qty
Signature of Lie. •ermittee
g A ,R ';lit8 _ — (nt if NLTr'f &mp f on 1 ='t= /
9 5 NAM p
,� 44 + i S 4 1' A55ACt usetts ° — 7 -
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2 I DEP tTMENT OF BUILDING INSPECTIONS 4 _'=1'� ^ = '
_
INSPECTOR l 2 Main Street • Municipal Building =-=
Northampton, Mass. 01060 or'
HOMEOWNER LICENSE EXEMPTION
ck) i A n � ( Please Print)
DATE: ; w
JOB LOCATION: /id (p 4-r.�
(Map) (Parcel) _ ubdivision)
HOMEOWNER: kt71 f a.6 fkLC si- Ct & t .4;- C °G 1 VD;
(flame & Address)
.etc- - i l l q sr '- is so
(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 0 CL-1; '
BUILDING PERMIT #
10. Do any signs exist on the property? YES NO )(
q,
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 - frnnt
- 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:
4 vol -ume - -& location)
_
13. Certification: I hereby certify that the information contained herein
c is true and accurate to the best of my knowledge.
.1.
DATE: ( &t q APPLICANT's SIGNATURE
NOTE: Issuance f a zoning permit does not relieve an applicant's bur n to comply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
FILE if
r r t? 1K
1 MAY 2 l 1997
r a. File No. 94,f7 7 I
!
ZONING PERMIT APPLICATION ( §10.2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Ap licant: 2C11,,(-M-- W
Address: 4 5,,,t ti ') Telephone: S _.•_( '- 1 -7 .
2. Owner of Property: 'LL OW C,A, LL c
Address: 1 4 Cl c 0 V A- 0 Telephone: Z -( 1 - ( --. 7 - 7
3. Status of Applicant: Owner Contract Purchaser Lessee
_ IX\ Other (explain): J
4. Job Location: ��,i_i i� Y
Parcel Id: Zoning Map# /D Parcel# �7 District(s): . . / Ve
- >C/
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property �G�1' 'Z�C. -�
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): •
e l--- - COO - T E 0 U' _t&-A b9-- S 'IL-
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 Specia / Permit/Variance/Finding ever been issued for /on the site?
NO J� 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)
°' 96 7
� ; f . F ILE I 4 , 4 „, ? _ 3
MAY j ) ii / Z
APP •� T /CCT�1'�ACT PERSON: �`
ADDRE .sf(HE
PROPER OCATION: f
MAP PARCEL: PARCEL: ZONE
THIS SECTION FOR - OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
7ONTNG FORM FTT,T,ED MIT ✓
Fee Paid
Building rmit Filled it , / p ) ✓�
Fee Paid C J ¥ a do 5 /d ad /�
Type of Cnnstriirtinn•
New Construction XD.
Remodeling Interior e,5 /
Addition to Existing
Accessory Strnrture
Building Plans Tnrinded-
1w npO'flccupant Statement nr 'license #
3 Sets of Plans / Plot Plan
THE IN
)LLOWG 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 -Bd of Health Well Water Potability -Bd Health
! Permit from Conservatio . ommissio •
4r4e
Signature of Buil. g . > .r Date
NOTE: Issuen•e of a zoning permit does not relieve an applioant's burden to oomply with all
_ zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
,„Amp7. City of Northampton REQUIRED INSPECTIONS
} 4 jr~ ' 1ti b ' BUILDING DEPARTMENT 1. Footing
s and Walls
�i
�
•" ''"� 2. Structural Components in Place*
3. Complete Building*
No. 423 Office of the Building Inspector
Zoning Form No. 962277 Date 5/21/97 Fee $20.00 Check # 432
Page, 18C parcel 96 , Zone UR8 Section 127 ❑ Yes 0 No
BUILDING PERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Richard Lavallee before Building Inspections
has permission to reshingle roof over 1 layer existing Inspection on Site — Foundations
situated on 4 Gleason Road 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, Inspection of Wiring —Rough
Maintenance and Inspection of Buildings in the City of Northampton.
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
** Install per Manufacturer's information: windows, vinyl siding, roofs
and woodstoves Smoke Detectors (Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON7 PRE ISES
Certificate ofIcupancy
Building Inspector