36-072 (4) NCD O M
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. - rE_-% 4 Alterations
NORTHAMPTON, MASS. �� _,t�;; ��—� 19 ,` Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location l -7 hie .�r,+ s o C:? Lot No.
.>,. �> / �� dx' Address �`/i °c-r> r /tta � t , j ✓� � zI
2. Owner's name i �%� �'- ��- � �� /�t'1 ---�-�= - � �-
3. Builder's name �r4t'1fi �t'R� 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 true to the best of his, her
knowledge and belief. y
-ee'
Signature of responsible appiicant
Remarks
O.�1WN p�O
► Mass:Hellustits.
il TMENT OF BUILDING INSPECTIONS '
NSPECTOR -— 12 fain Street ► Municipal Building '
DEPT OF BUILDING INSPECTIOP4S
NORTHAMPTO MA 01060 Northampton, Mass, 01060
# N
HOMEOWNER LICENSE EXEMPTION
( Please Print )
DATE: �� �, .��,,r�
JOB LOCATION: '? �`�' ��+ n'✓ G��t "
(Map) (Parc 1 ) ( Subdivision)
HOMEOWNER: /
(Name & Address )
_25-i76 5'
( 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
t+/ill 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 #
{" �u IPA-OtfpTO lain Of 'Wart �antptnn
Se 2 2
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DEPT�OF c°El U MFNT OF BUILDMG INSPECTIONS
NORTHAMPTON MA 61GFi Street Municipal Building
Northampton, Mass. 01060
WORKER'S CO YIPENSATION INSURANCE AJiTi AVIT
2402
(li censerJperrni ttee}
with a principal place of busimssJresidence at:
`7, 7 f� ' ?�/'i r rn c� r��r �`��! (phone#) J Y 5 7U _
(streei/citylstate/zi p)
do hereby certify, under the pains and penalties of pegury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees worcing 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/Poliq Number) (Expiration Date)
(Name of Contractor) (Insurance Comp 0 cr Number) (Exoirancri Date)
(Name of Contractor) Gmuance Company/Policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional theet ifnoccnlxy to include iafb- on pertaining to nil c«rtrndors}
(k)"'I am a sole proprietor and have no one wonting for me.
( ) I am a home owner performing all the work myself.
NOTE:please be awarr that while homcouncrs who t�rplay perronc to dam :*r.-+ ...� ciion or repair tivorSc on a dwelling of
not more than tbrue units iia which the homeowner rm&3 or oo the gotrnds aFrartentd thereto arc oat&cncrnlly ooasidcrcd to be
employers under the workces oompcnsation Act(GL152,s 1(5)),application by a homcowncr for a liccnte or permit may evidence tho
legal ctstus of an employer under the Wocka c Compomatioa Act
I un&rztxnd this a copy of thin rri==A may be forwarded to the DtVn t xc of Ir,&�al Ancidm&Of5oo of rmsuraoco for the
coverage vcriflcatioa and that ail=to secttrc covcmgo under section 25A of MOL 152 can leld to the imposition of criminal pcualtics
coesisting of a fqe of up to S1,300.00 and/or impraossmcr3 of tip to one ytar And civil penshia in the form of it Stop Wait Order and a
lino of 5100.00 a day against tae_
n For&p=t==td trio onlY
-� Permit Number
/. N fap# Lot#
Signattttti of LiccnseelPemutix
P
10. Do any signs ebst on the property? YES NO-;r -' yr
a �
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES NOS_
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This coiamm to be filled in
by the Banding 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:
{vo1-ume-4 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 =f
NOTE: lssuance of a zoning permit does not relieve an applioanre burden to oomply Mitt okll
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appiioable permit granting authorities.
FILE #
(;,
r
SEIP 2 2 ,see
DEPT OF WILD
INGindt File No.
`... NORTHAMPTON
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: `fi' c�' L.•+C 'c Telephone: '
2. Owner of Property:Address:—A//-;? g�"�=a /r��? .�� Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): f
4. Job Location: iy/% Z'"' e: ' 'y /V't; ,f J
Parcel Id: Zoning Map# —36, Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property �t
6. Description of Proposed Use/Work/Project/Occupation: (Use additional�sheets if necessary):
�C`6>�/� �/''7�/ Lb d'� _ d3 .a- /��C,!-�'w;'��y 7 •sZu,�,�-�` .i°�y.'�7C� ��
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 I,s` 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? NOS 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)
File#BP-1999-0316
APPLICANT/CONTACT PERSON Laurence Cadorette
ADDRESS/PHONE 417 Westhampton Rd (413)585-9705 O
PROPERTY LOCATION 417 WESTHAMPTON RD
MAP 36 PARCEL 072 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT ��//
Fee Paid
Building Permit Filled out
Fee Paid
Type of Construction:
New Construction
Non Structural interior renovations
Addition to Existin¢
Accessory Structure
Building Plans Included:
Owner/Occu ant Statement or License#
3 sets of Plans/Plot Plan
THE F LOWING 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 Commission
Signature of Build* g Offic Date
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.
Department: Reference No: 1BP-1999-0316
...................................
Building,Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Non structural interior renovations REC-1999-000808
.........................................................................................
...... ...............................
Paid By: Paid in Full On:
Laurence Cadorette Tue Sep 22,1998
................. .. . ...... ......
.Received By.:................................................................. .Check. .No....................
Linda Lapointe 114
.........................................................................................
......................................
DEPARTMENT'S COPY Amount: $40.00
...........................
DEPARTMENT FILE COPY 417 WESTHAMPTON 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:
22 Sep, 1998 BP-1999-0316 $40.00
GIS #: Man Block: Lot: Address: Zoning: Use Group: Lot Size:
7158 36 072 001 417 WESTHAMPTON RD SR 199069.2
Contractor: License Type: Insurance:
Homeowner as Contractor
Address: License No.: Insurance No.:
City: State: Zip Code: Phone:
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0657 Non structural interior renovati $1,500.00
Description of Work:
FRONT PORCH REPAIR
GeoTIVIS@ 1997 Des Lauriers&Associates,Inc. Signature: