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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
O,1y Sv,y.
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
<-i:`
(licenser/permiuee)
with a principal place of business/residence at:
(phone#)
(street/city/state/zip)
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)
( ) 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/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach addidoml shed ifnecessuy to iociode information pertaiaiag to all ooatraaors)
( ) I a sole proprietor and have no one working for me.
(( a home owner performing all the work myself.
NOTE:please be aware that whilo homeowners who employ pc=m to&fen=ce,mint ueuoaor repair work on a dwelling of
not more than throe units in which the homeowner reside or on the grounds app=tenaathereto are not generally oonikk d to ba
employers under tho vmd='a oempe=dion Act(GL I52,ss 1(5))�application by a homeowner for a license or p=k may vhdm-the
legal&I-ao of an employer under the Wodcoes Compensation Art
I undttstaad that a oopy of this statement maybe forwarded to the Depart cn t of Industrial Aoddents,Ofoe of Insurance for the
covetsge Verification and that failure to&==coverago under sectioa 25A of MGL 152 cam lead to tha imposition of criminal penalties
oomisting of a fine Hof up to S1,500.00 andlor i mprtsorm erd of tip too=yew and civil penalties in the form of a Stop Work Order and a
fmo of 5100.00 a day spla d tuo.
For dial—only
'Peimit Number
^` v Map# Lot
of Liccnsee(Permitt,ce Date
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'*<s. DEPARTMENT OF BUILDrNG INSPP_CTIONS
INSPECTOR 212 Mnin Street ' Municipal Building '
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
c�+^ ( Please Print)
DATE; 3JIV7 1 I
JUB LOCATION : 1AP
T a Parcel ) � Su'�d�visi
( p �( ( on)
;
HOMEOWNER: A�(� �^^ Cx 611-
(Name & Address )
F 'S
( Home Phone ) (Work Phone)
The current exemption for 'homeowners" was extended to include
Owner-occupied Dwellings of one ( 1 )or tti,ro (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 `-OP . 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 per°iod 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 c;7ork 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 responsibi-lit-y
for compliance with the State Building Code , City of Northampton
Ordinances , State and Local Zoning Laws , and State of Massachusetts
General Laws Annot to .
HOMEOWNER SIGNAT
BUILDING PER MIT
the Home De P ot ;#2662 -179, ET DRIVE, W. SPRINGFIELD, MA 0108
Sat Jun 20 13 i 01 : 33 19-98
Che materials in this deck will cost $521 . 31
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)eck Dimensions for Deck 1
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Deck 1
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Sat Jun 20 13:01:391998
File saved as: c:\cgdesign\decks\5866585b.DEK
Construction Specifications
Deck 1:
Construction Method = Beam to Side of Post
Footing Type = In-Ground
Live Load = 60
Dead Load = 10
Decking Spacing = 0.125 in
Joist Spacing = 16 in
Beam Spacing = 72 in
Post Spacing = 96 in
Decking = 5/4X6 .40 Sealed Southern Pine No. 1
Beams = 2X8 .40 Treated Southern Pine No. 2
Joists = 2X6 .40 Treated Southern Pine No. 2
Posts = 4X4 .40 Treated Southern Pine No. 2
Deck Height = 60 in
Diagonal Bracing = No
Deck Skirt = No
Joist Overhang = 12 in
Beam Overhang = 12 in
Decking Deflection Factor = 360
Joist Deflection Factor = 360
Beam Deflection Factor = 360
Pref Decking Size =
Pref Joist Size = none
Pref Beam Size = none
Pref Post Size = none
Railing 1:
Railing Height = 36 in
Baluster Spacing = 3.75 in
Post Spacing = 96 in
Stair 1:
Step Width = 36 in
Step Height = 60 in
Step Rise = 7.5 in _
Step Run = 11 in
Stringers = 2X12 .40 Treated Southern Pine No. 2
Risers = 1 X6 .40 Treated Southern Pine No. 2
Treads = 5/4X6 .40 Sealed Southern Pine No. 1
Railing 3:
Railing Height = 36 in
Baluster Spacing = 3.75 in
Post Spacing = 96 in
Railing 4:
Railing Height = 36 in
Baluster Spacing = 3.75 in
Post Spacing = 96 in
Railing 2:
Railing Height = 36 in
Baluster Spacing = 3.75 in
Post Spacing<= 96 in
Railing 6
Railing Hag t 36rm
BalusterrSpacmg 3.75 m
Post Spac g. ...
R ^
1" i
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?ost Layout for Deck 1
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6' 10" 6' 10"
l l 211 1' 21,
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Dat Jun 20 13 : 01: 33 1998'
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'fills,-PLAT IS FOR IDENTIFICATION PURPOSES ONLY AND DOES LM CONSTITUTE A PROPERTY°SURVEY
AUG 1 21997
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MARY DAME bgkE
ro-mE Wk-MAGE CORP_
AND 71I1: FIP.S`T HMERICANTrT1.E Co—01JLY
1b the best of my knowledge,information and belief,I hereby report that 1 have examined die premises and that this inspection plat shows dl(
improvement or improvements as located on die premises described,that the Improvement or improvements are entirely within lot lines,d►a
there are no encroachments upon the premises described by die improvement or improvements of any adjoining premises,and drat there arc
no easements ofrecord affecting die tract shown hereon,except asshown.
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 V
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
Thin cclamm to be filled in
by the R=1d2n9 Department
Required
Existing Proposed By Zoning
Lot size u d,000 Sr-r Sf J
Frontage
Setbacks 10 1A A a
side L: R: L: � R: �
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paged parking'
# Pf �Parking spaces
AuN�
# 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 knowledge,-
DATE: �^Mj L� ;� 1 ► � APPLICANT's SIGNATU 4�ampplloantiai I � � U.� ,I NOTE: l anuanoe of a zonin g permit does no! relieve burden to comply with,,ptl-
zoning requirements and obtain all required permits from the Board of Health, Con$ervtstion
Commission, Department of Publio Works and other appiloable permit granting authoritlea.
FILE #
JUN �
2 4 1998
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: �Y4�-� )L�.V t_h��T ��4�,,'�ln�C.`� t+AA Telephone: (q)3) b
2. Owner of Property: `��.►� M, 1Z.IZ V%A,.0 S t 1
Address: SA*t Telephone: Uw
3. Status of Applicant: �" Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: ! `
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property '*, � Sk�jt;L5
6. Description of Proposed Use/Work/Project/Occupation: (Use additional 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/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW k/ 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__z_ 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 #.96 8 713
3
JUL 21 998
.P LICAN T CT PERSON-
PROPERTY LOCATION:
MAP PARCEL: 0 V ZO
THIS SECTION FOR-OFFICLAL USE ONLY:
PERNIIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONITN(' FORM FH,T,FD OTTT
Fee Pniri
'Building Permit Filled nut.
-Fee pnifi
Arresmj-y gtriic iire
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION'
Approved as presented/based on information presented
Denied as presented:
_ZSpectal ermit and/or Site Plan Required under: §l6. 9
CZ
PLANNING BOARD ZONING BOARD
Received & Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § NY/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-Bd of Health 'Well Water Potability-Bd Health
_Permit from Conservatio ommissiou
Signature of Building 150ctor Date
NOTE: lnsuanoe of a zoning permit does not relieve an applicant's burden to comply with all
zoning requirements and obtain all r"L;.ired permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.