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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. � • -S / Alterations
NORTHAMPTON, MASS. �� 19 Additions
' APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location i��(�S �e L h,re�-o e c, Lot No. _
2. Owner's name ✓I t i?/1k eL- ,—o Ka n°o Address �r Ci ` {f �t'! G,rJ�r /1 /fit :rYi/ C
3. Builder's name -P `Z Address ! ^/v. _,10 -
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration de-
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:- yCiG
The undersigned certifies that the above statements are we to the best of his, her
kn edge and belief.
1-
Signature of responsible app,icant
Remarks
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m / 19Q� DEPARTMENT OF BUILDrNG INSPECTIONS
4 212 Main Street ' Municipal Building
Northampton, Mass. 01060 `
WORKER'S CO'KPENSATION INSURANCE A.FI'IDAVIT
(licenserJpermittee}
with a principal place of business/residence at:
(stnsUcity/staL' zip)
do hereby certify, under the pains and penalties of perJi.iry, that:
( ) I am an employer providing the following workers compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Datt)
( ) I am a sole proprietor, general contractor(o homeowner(cycle one) and have hired
the contractors listed below who have the following Worker's compensation policies:
(Name of Contactor) (Insurance Comrlazly/Poliey Number) (Expimnn Date)
(Name of Contractor) ans-di nc:z Companv/PoLc-,1 Nur1ber) (Expimuon Date)
(Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Dale)
(Name of Contractor) (Ins�lrance Compalry/Policy Number) (Expiration Date)
(attach additloail z^.eet if n«rssary to include informiiioc pcxtaiaing to all cocltractors)
( ) I am a sole proprietor and have no one working for me.
(a/)'1 am a home owner performing alI the work myself.
NOTE:please be aware that whilo hCmcouvcta Hfrs Cmploy paeans to 67 m R,t,-. Cr corsruction or repair work on a dwelling of
not morn than threc units is of ich the bomoowner rcid a cc oa the grounds appurtcawt thereto art oo(gcna2lry coosidcmd to be
employers under tho s oompcasation Act(GL152,ss 1(5)),applicz-6on by a homcow=for a l o=a a p-Md may evidence tftc
legal ctntua of an employer under tbo Wor4e&Compeasaiion AcL
I undeniand that a copy of this ehicmcni may bo f;>M-W ded to tho DcVa tmcrsi of hsdustri ai A=&Q&OfS of Irauranco for the
coverage verification and that failure to seatro covcmv tmdcr scctioa 25A of MOL 152 can Icad to tba impositioa of aiminal pcanitic
oomilting of a fitx of up to S1,500.00 aadlor of tip to oae year and civil pcnaltic in the form of a Stop Work Otdcr and a
firm oC5100.00 1. ay agaiaA toe.
For igart�l uao only
Permit Number
�t Map# Lot#
of Li crmittee
f 'Waz#lIa»tptall
its on C11 Ito e I I%
DEPARTMENT OF BUILDITIG INSPECTIONS
41 998
INSPECTOR 212 Main Street Municipal Building
Northampton, Mass, 01060
HOMEOWNER LICENSE EXEMPTION
DATE: 1t
(Please Print )
JOB LOCATION:
ap) (Parcel) ( Subdi HOMEOWNER: f c re n°
(N me & 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 . 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 .
t
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 Annotate
HOMEOWNER SIGNATURE �.tC-� (�`1 C�,�_ J,__
BUILDING PERMIT
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10. Do any signs ebst 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 color= to be filled is
by the Budding Department
Required
Existing Proposed By Zoning
Lot size O 7 ? ���j �Jj
Frontage
Setbacks a if
- side L: R: L: R: _
- rear I v
a
Building height
Bldg Square footage &6P0 yv'�x
%Open Space:
(Lot area minus bldg L��D
&paved parking)
# of Parking spaces
e of Loading Docks
Fill:
{vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my kn ledge.
d
DATE: t l APPLICANT's SIGNATURE
NOTE: lssuano of—a zoning permit does not relieve an plioanra burden to oomply Wpl) +pii
zoning requlraments and obtain all required permits frlwb the Board of Health, Conservation
Commission. Department of Publio Works and other appitoabla permit granting authorities.
FILE #
AUG 4 11998
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant. a !% ` C�
Address: ) k v Telephone:
—� �. p
2. Owner of Property: /l,� i� �E, ,� �t _�� )—a- /I rte°��
Address: S Telephone: ,
3. Status of Applicant: L,-"Owner Contract Purchaser Lessee
Other(explain): /
4. Job Location: '
Parcel Id: Zoning Map#_ / /� parcel# c� � District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property V)//
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
20 2
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 KNOW t/ 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? NOL - 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-1999-0147
APPLICANT/CONTACT PERSON Cynthia Larareo
ADDRESS/PHONE 60 Sheffield Lane (413)586-57310
PROPERTY LOCATION 60 SHEFFIELD LANE
MAP 17C PARCEL 123 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
T e of Construction:
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Occupant Statement or License#
3 sets of Plans/Plot Plan (ice
T OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presentedibased 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 ission
i r
Signature of Building 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.
Reference No: BP-1999-0147
Department: ...................................
Building, Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Building- Renovation REC-1999-000267
Paid By: Paid i n Full 0 n
Cynthia Larareo 'rue Aug 4,1998
..................................................................................... .......•---........---................1
Received By: Check No:
Linda Lapointe 6657
......................................................................................... ........•..........•..................
DEPARTMENT'S COPY Amount: $40.00
...........................
DEPAR'T'MENT FILE COPY 60 SHEFFIELD LANE
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:
07 Aug, 1998 BP-1999-0147 $40.00
GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size:
1758 17C 123 001 60 SHEFFIELD LANE URB 24785.64
Contractor: License Type: Insurance:
Homeowner as Contractor
Address: License No.: Insurance No.:
Li!r State: Zip Code: Phone:
Project N Category of Work: Const. Class: Cost Estimate:
JS-1999-0217 alteration-addition $4,000-00
Description of Work:
CONSTRUCT 20' X 20' DECK
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: