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25C-093 (9)
a � A © h c t 3 o D m c co y z r O a v Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations a NORTHAMPTON, MASS. 19 Additions APPLICATION FOR PERMIT TO ALTER Repair � p y 1 Garage `ll. Location �°�� t}N � - rev �n Lot No. 2 Owner's name L. Address 3. Builder's name Address Mass.Construction Supervisor's License No. Expiration Date 4. Addition s Alteration_►`� D-a O N� e I at C l o Q °� c \ c�r S r� 6. New Porch 7. Is existing building to be demolished? S. Repair after the fire 9. Garage No.of cars Size 10. Method of heating 11. Distance to lot lines 12. Type of roof 133. Siding house �4/. Estimated cost- �Tte u ne ertifies that the above statements are we to the best of his wledge an lief. G� Signature of responsible app icant emarks lu-a '�L A t-o T 0 t/ -90 Q-� NP <Lx «Y f laf Xarthampfon `8 6 DasaacElnsctts MOM r , JAN 3 ��(��)E ENT OF BUILDWG INSPECTIONS 212`train Street ' Municipal Building ' A Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT L. f (licenstdpermiuee) with a principal place of business/resideuce at: hone# (P ) (str clJcity/s &2:iP) 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) (L)*I am a sole proprietor, general contracto homeowner ' cle one) and have hired the contractors listed below who have the following wor e s compensation policies: (Name of Contractor) (Insurance Compaay/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/PoUcy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additiand rhea ifneoeaary to include inforautioa p<rtaiaing to all 000kadors) ( ) 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 ague that%vWo homaowncrs who employ pare=to do mai ac=bce,coastruc =or repair work on a dwelling of not mode they toms emits is which the bo mw%mw resides cc on the grouryds app 1e,= d thane are act Sox ily o mxkrcd to be aaployaa tmdcr the vmckees ooaVcnu4oa Act(GL152,ss 1(5)),application by a homeowner for a license or permit may-idc=tbo legal a2i=of an amployor under the w"keea coaopemation Act. I undawAnd that a copy of this cutemeut may be forwarded to the Departaxat afln&1xbial Aod&a&Oboe of Iaxu+oce for the coverage verification sad that failure to secure ooverago under soction 25A of MOL 152 can kid to the imposition of aiminal peaaitita oomist mg of a fmc of up to 51,500.00 aad/ot imprison of up to one year aad civil pcuzWes is the form of a Stop Wort Order and a fim of 5100.00 a day agnind the - For dgmtmwW tun only Permit Number Mao Lot# Signature;of Licensee/Permitttx •a*Ffe .._ .. et..iY,a-rtiM'Xlcr:.'.-: OQTTW/PTO D LY of 'War lIallyfall e � • �xaaxc4axclb DEPT OF SUgLt?!'aG 1NSPFxJTfO�6' T NT OF BUILDING INSPECTIONS INSPECTOR ...- n Street ' Municipal Building Northnmpton, Mass. 01060 +•• • HOKEOWNER LICENSE EXEI•IPTION ( Please Print) DATE: ,ry- JOB LOCATION:- �/� /,�KT'7 ST'>�'�0'44, � i 1( ap) ( Parcel ) /� ( Subdiv sion ) HOMEOWNER: ' }-(,(1, I�. I--t�►%T -3 6T0_V-'J N' Q (Name & Address) �/3 -4s (Home Phone) (Work Phone) The current exemption for "homeowners" was extended to include Owner-occupied Dwellings of one ( 1 )or tiro (2) fami 1 ies 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 reside's 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 cofistruets more than *one home in a two-year. pe 'r'iod shall not be considered a 'homeowner. - Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, Oiat' he/she shall. be responsible for all such work performed under: they bui°ldiiiq permit'. As acting Construction Supervisor your presence on the: j,ob site will be required from time to time, during and upon completion' a f 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 fassachusetts 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 Z ing Laws, and State of Massachusetts General Laws Annotated./ t HOMEOWNER S I GNATURE V / BIIYLDING. PEJZMIT ,•; 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. zhi.a CO2— to be filled in by the Building Diepart—nt Required i Existing Proposed By Zoning i Lot size Frontage Setbacks side L: R: L: R: - rear Building height Bldg Square footage %Open Space: (Lot area minus bldg &Paved parking) # of -Parking Spaces e of Loading Docks Fill: {vol-ume--& location) 13 . Certification: I hereby certify that thelinform Lion c ntained herein is true and accurate to the best of my Xnowle e. DATE: G$ APPLICANT's SIGNAT[IIr ' NOTE: Iss an ® of a zoning permit does not relieve an applioanru burden to oompty wkt" all zoning requirements and obtain all required permits from the Board of Health. Conservation Commission. Department of Publio Works and other applionbla permit granting authorities. FILE # a.__LL L � Fi1e No.vvoe j `!7P?OF91s" Y riN ') g ._.._ ' _,PERMI T APPLICATION (510 . 2) PLEASE TYPE OR , PRINT ALL INFORMATION \ 1. Name of Applicant: "� u A t"T Address: '�2 /5 IT• Telephone: 2. Owner of Property: �w 11 6� LT— Address: G - Telephone: 5-i5l—z}73 3 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): y� / 4. Job Location: �G`acs A0 Parcel Id: Zoning Map# 1--e2i Parcel#_ District(s): (TO BE FILLED IN BY THE BUILDING DEPARTMEN S. Existing Use of Structure/Property 6 t" 6. Description of Proposed Us / or ro'ect/Occupa io : (Use additions sheets if necessa ): v rt rm ve �t o v a t S 5 06 r d V_0� 4cs -Ve-j' rv-It- A/M$:4'e_ 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 I Ll� 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 v 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-2000-0633 APPLICANT/CONTACT PERSON HOLT PAUL L&PAMELA K ADDRESS/PHONE 215 NORTH ST (413)584-4933 Q PROPERTY LOCATION 215 NORTH ST MAP 25C PARCEL 093 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid 15"0-5-7 0-5-0- Typeof Construction: REMOVE&REPLACE ROTTED FLOOR JOISTS- 1 ST FLR-TERMITE DAMAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE LLOWING 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 Commissi Signature of Building Officia 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. 215 NORTH ST BP-2000-0633 GIS#: COMMONWEALTH OF MASSACHUSETTS ellk iau:Block:25C-093 CITY OF NORTHAMPTON Lot:-001 Permit: Buildinq Category: TERMITE DAMAGE BUILDING PERMIT Permit# BP-2000-0633 Project# JS-2000-1141 Est.Cost: $3000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Lot Size(sq.ft.): 17903.16 Owner: HOLT PAUL L&PAMELA K Zoning:URB Applicant• HOLT PAUL L & PAMELA K AT. 215 NORTH ST Applicant Address: Phone: Insurance: ISSUED ON.1/7/00 0:00:00 TO PERFORM THE FOLLOWING WORK.REMOVE & REPLACE ROTTED FLOOR JOISTS - 1 ST FLR - TERMITE DAMAGE 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 SiSnature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 1/7/00 0:00:00 5057 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo