35-010 (2) a 2
! -o > o
1
o
} a
� z
oa, > O
Z C
� � O rt'1 C
r
Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location ��� r/�'�-`� Acl Lot No.
2. Owner's name , Ero w i,�_ Address
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
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are we to the best of his, her
knowledge an belief.
-7T
Signature of responsible app icant
Remarks
oO�
� a t
AUG1 9 t���pQ
f� p :saachttsctta
m
LD� 11��R lain ENT OF BUILDING INSPECTIONS
DEPT OF 811�NQRTHA ,' ) k3,�CIi' Street ' Municipal Building '
Northampton, Mass. 01060 '
WORKER'S COlYLPENSATTON INSURANCE A.TITIMA.VIT
with a principal plane of business/residence at:
(phone#)
(s tmet/ci ty/staie/rzi p)
do hereby certify, under the pains and penalties of perwuy, that
( ) I am an employer providing the follotiving worker's compensation coverage for my
employees working on this job:
(Insl=ce company) (Policy Number) (Expiration Dale)
( ) I am a sale proprietor, general contractor o homeown_ (circle one) and have hired
the contractors listed below who have the following wor el's compensation policies:
(Name of Contractor) (Insur- nc�_ Coinaany/Poticf Numbcr) (E.Tim, iott Date)
(Name of Contr:ctor) (Insarancc Company/Polio Number) Date)
(Name of Contractor) (Insurmcc Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurancc Compmy/Policy Number) (Expiration Date)
(a-di additional slid ifncceauy to ineludc iafrnuution pertaining w all radon)
O 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 Wh:ilo homcowvm%NtO employ perm=to do UI %*jCU=cr cost ictioa or repair work on a dwelling of
not mote than throo units i a wlxicb tha homoowna rmdcs or oa the grounds appurtenant ih=to arc oct gr: a oanidcrcd to be
cmploycta under the worker's oornp=s4ca Act(GL152 sat(S)) application by a homeowner far a liaise or permit may cvidcna the
legal status of an omployec undar the workees conve i Act
I understAud thst a copy of this ctaicmcnt may bo fory mxr.e to tho DcQarb o d of Iodusuial A,a&C>'Offioo of Iostuwaos ford's
coverage verification and that failure to tea=covcrabo under scctioa 25A of MOL 152 can lmd to the"imposition of criminal penalties
com ist Ma of a fim of up to S 1,300.00 and/or irapriso�of tip to one yar and civil penalties in the form of a Stop Work Oats and a
firm of 5100.00 aifay tgainst t»a. ..
For dqMt=rtd use city
C Permit Number
Map# Lot#
Si of LiccnscrlPermittee
w' J
iif� of 'Nortilally toll
e 9 i998 7
AUG + asaacl�usetla
L
DEPTTR80"�.. DEPARTMENT OF BUILDIJIG INSPECTIONS
INSPECTOR `�, Main Street ' Municipal Building
NORTN�s;,,• G� �.;; .,12
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
DATE:
(Please Print )
(��f �-
JOB LOCATION:
(Map)
(N (Parcel) ( Subdivision)
HOMEOWNER: g d/
(Name & Address)
VX
( 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 ` �-
BUILDING PERMIT #
10. Do any signs ebst on the roe YES NO A.
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 colama to be filled is
by the Bnileang Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L: R: L: R:
- rear
Building height
Bldg Square footage 3 -7
%Open Space:
(Lot area minus bldg
&paged parksngj
# of -Parking Spaces
#` of Loading Docks
Fill:
(vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and paccurate to the best of my know edge.
DATE: F l 9 pU APPLICANT's SIGNATURE
NOTE: Issuance of a zoning permit does not relieve an a lio nt's burden to comply wlth'all
zoning requirements and obtain all required permits fro th Board of Health, Conservation
Commission, Department of Publio Works and other app oable permit granting authorities.
FILE #
AUG 1 91,998
ffo&?'�PTOFSI1,.. File o.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: T E r-06oll-
Address: vim/ /�,'Ps� /'/''S tom/ Telephone: , /3 � �jl `T
2. Owner of Property: aV71-7
Address: Telephone:
3. Status of Applicant: Owner C' /Contract Purchaser Lessee
Other(explain):
4. Job Location:
Ao/
Parcel Id: Zoning Map#_S,-� Parcel#_ District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property �4��—
`r
6. Description of Propo ed UseAlVork/P oje t/Occu Paton: (Use additionaj sheets if necessary):
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/Vadance/Finding ever been issued for/on the site?
NO ✓ DON'T KNOlN' 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)
Department: Reference No: BP-1999-0218
...................................
Building,Electrical& Mechanical Permits
..........
Fee �W�: Receipt No:
Roofing REC-1.999-000429
... .....................................................................................
......................................
Paid By: Paid in Full On:
Jody Brown Thu Aug 20,1998
.........................................................................................
......................................
Received By: Check No:
Linda Lapointe 1,279
.........................................................................................
....................•.................
DEPARTMENT'S COPY Amount: $20.00
.....................
DEPARTMF.',NT FILE COPY 51 WEST FARMS RD
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:
20 Aug, 1998 BP-1999-0218 $20.00
GIS Map Block: Lot: Address: Zonina: Use Group: Lot Size:
6832 35 010 001 51 WEST FARMS RD SR 24219.36
Contractor: License Type: Insurance:
Homeowner as Contractor
Address: License No.: Insurance No.:
Liy-i State: Zip Code: Phone:
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0365 roofing $1,200.00
Description of Work:
STRIP & SHINGLE ROOF
GeoTIVISO 1997 Des Lauriers&Associates,Inc. Signature: