25C-011 (4) � I 1
MAY 1 I {999
DEPT OF BU4E't �,'G�NSP�ECT1 �dS
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APARTMENT OF BUILDING INSPECTIONS
MAY
INSPEC OR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
PT OF
TI,_ ,
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE:
JOB LOCATION:
(Map) (Parcel) (Subdivision)
HOMEOWNER:
(Name & Address )
(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 .
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 4 «1 OL ;
BUILDING PERMITL
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
'
APPLICATION FOR PERMIT TO ALTER Repair
Garage
)
1. Location �� �� /o��'� � -�� �!` �f/U�z, i/ Lot No.
a
2. Owner's name ,11 is �1 / f r tir d 7_ (',4t, ) l F t i t Address
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition o x h ck
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 suatemcnts are we to the best of his
know g an All
l
Signature ofresporesrble appicant
i
Remarks
"MP f D C
MAY i 1 Crz� of 'Nart4aillptan z
�lassachnsetfs _
FPT OF
$(IE !r D PARTMENT OF BUILDING INSPECTIONS
INSPECTORM1 "° °°µ- �% 212 Main Street • Municipal Building '>o
Northampton, MA 01060
Applicant Information ,& `I Ve 5
�.,Pdame I t. L 1 - _ ,- v- _-1 r f 111
City, , - ��,- ��,- vYTlg �J1L-- ----------
1 am a homeowner performing all work myself
I am a sole proprietor and have no one working in any capacity
❑ 1 am an employer providing workers' compensation for my employees working on thisjob.
Company Name ------------------- --
Address
City ------ ----- Phone#--------
Insurance Co._------------_—Policy#----- ---
Company Name
Address
City Phone#
Insurance Co. Policy#
Failure to secure coverage as required under Section 25 A of MGL 152 can lead to the imposition of criminal
penalties of a fine up to$1500.00andlor one years'imprisonment as well as civil penalties in the form of a STOP
WORK ORDER and a fine of$100.00 a day againstme. I understand that a copy of this statement may be
forwarded to the Office of Investigations of the DlAfor coverage verification.
I do hereby certify under the pairs and penalties of perjury that the information provided above is true and correct.
Signature Date
Print Name Phone#
Official Use Only Do notwrite in this area to be completed by city or town official
City or Town PermiULicense# ❑ Bmldi' 1A
❑Lreming Bond
Check if immediate response is required
Contact Person ❑sele�'Dept.
Phone#
Hea$h Dept.
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10 Do any signs exist on the property? YES NO
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 cold to be filled in
by the Building Deportment
I Required 1
Existing Proposed By Zoning
I Lot size f � �� J 3 G,
-- J fi l Utrz
Frontage 9
Setbacks - frnnt �o
- side L: R: L:a R:
- rear �L
Building height
Bldg Square footage , �� eD
%Open Space:
(Lot area minus .bldg AID,)
&Paved parking)
# of Parking Spaces v
# of 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: - APPLICANT's SIGNATURE
NOTE: Issuanoa of a zoning permit does not relieve an applicants burden to oomply with .011
zoning requirements and obtain all required permits from the Board of Health. Conservation Commission. Department of Publio Works and other appliooble permit granting authorities.
FILE #
ILI
F, �
File No
21 T,7 L"' JMV� x� ��� �� � �
����"� �����^� ==� =�==��=^~ « �r��= ^ ��
PLEASE TYPE OR PRINT A.LL INFORMATION
1. Name of Applicant:
Address Telephone:
2. Owner of Property:
'
Address: Telephone:
3. Status ofApplicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
~
Parcel Id: Zoning K8op District(s):
�\} BE FILLED |N8Y THE BH|LO|NGDEPARTMENT)
5. Existing Use o/Structure/Property
6. Description of Proposed Uoo/Work[,rojeot/Oonupabon: (Use additional sheets ifnouasoaqy):
U
7. Attached Plans: Sketch Plan Site Plan Engineorod/Sun/eyadP|uns
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 w~ YES |F YES,date issued:
IF YES: Was the permit recorded ot the Registry ofDeeds?
NO DON'T KNOW TES________
IF YES: enter Book Paga end/or DnounnonL
Q. Does the site contain o brook, body of water orwetlands? N c~^, DON'T KNOW YE3_______
IF YES, has permit been ur need to be obtained from the Conservation Commission?
Needs bobe obtained Obtained .date issued:
(FORM CONTINUES ON OTHER SIDE)
File#BP-1999-0948
APPLICANT/CONTACT PERSON FENTON JOHN ROBERT&JOAN A
ADDRESS/PHONE 164 NORTH ST 586-5589
PROPERTY LOCATION 164 NORTH ST
MAP 25C PARCEL 011 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildinia Permit Fillea out
Fee Paid 6
Tvneof Construction: ERECT 10 X 12 SHED
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THIS LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
L/A �ved as resented/based on information resented.
Pp P p
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 Commis
Signature of uilding Official 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.
164 NORTH ST BP-1999-0948
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 25C-011 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Cateyo�y: shed BUILDING PERMIT
Permit# BP-1999-0948
P_roiect# JS-1999-1620
Est. Cost: $1800.00
Fee: $20.00 PERMISSION IS HEREBY GRANTED TO:
Coast. Class: Contractor: License:
Use Group:
Lot SizeCsg. ft.l. 13895.64 Owner: FENTON JOHN ROBERT&JOAN A
Zoning:URB Applicant:_
AT. 164 NORTH ST
Applicant Address: Phone: Insurance:
ISSUED ON.511411999 0:00:00
TO PERFORM THE FOLLOWING WORK.-ERECT 10 X 12 SHED
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 5/14/1999 0:00:00 $20.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
_---.�_.�.�.w._ ....-��w.. __. _ .. .... .
�\
164 NORTH ST BP-1999-0948
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25C-011 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: shed BUILDING PERMIT
Permit# BP-1999-0948
Proiect# JS-1999-1620
Est.Cost:$1800.00
Fee:$20.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group:
Lot Size(sg.ft.): 1 83 95.64 Owner: FENTON JOHN ROBERT&JOAN A
Zonin¢ URR Applicant:_
AT: 164 NORTH ST
Applicant Address: - Phone: Insurance.
ISSUED ON.511411999 0.00:00
TO PERFORM THE FOLLOWING WORK.-ERECT 10 X 12 SHED
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: Q
THIS PERMIT MAY REVOKED BY THE CITY OF NORTHAIVkON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
j f i nature•
Fee Type: Receipt No: Date Paid: Check No: _ Amount:
Building 5/14/1999 0:00:00 $20.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo