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12C-092 (4) S n- TIM e `$ GrX of Nart4Mllipta l ID y.TaSSttt}lttSt11S 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 �•(IiAAf A ' .fie �y+ "�Y�, h� � �. � y a.""`° �� .4 i����. �• Grit d x-dzflia*iii}ifaii =Y - �. - �asaxcf)usclla '*<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 ?ile saved as : c : \cgdes,ign\decks\5866585b .DEK >D View J� V- x� ��J 1 i� J �\ (�- N d the Home Depot #2662, 179 DAGGET . DRIVE, W. SPRINGFIELD, MA 0 gat `Jun 20 ' 13 : 01 : 33 1998 z . ?i1e saved as : c : \cgdesign\decks\5866585b .DEK )eck Dimensions for Deck 1 81 CO ................. _ Deck 1 8' f ;G F u The Home Depot #2662, 179 DAGGET DRIVE, W. SPRINGFIELD, MA 01089, (413) X31-9700 = 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 ncd Home Depot ##2662, 179 DAGGET DRIVE, W. SPRINGFIELD, MA 0108 gat Jun 20 13 :'01 : 33` x:,998 ?ile saved as c : \cgdesign\decks\5866585b .DEFt ?ost Layout for Deck 1 M 6' 10" 6' 10" l l 211 1' 21, --------------------_ ----------------------- BasePoint - - m � the Home Depot #2662 , 179 DAGGET DRIVE, W. SPRINGFIELD, MA 010'8 Dat Jun 20 13 : 01: 33 1998' ?ile saved as : c : \cgdesign\decks\5866585b .DEK )eck Layout - ink r Er I'r Wl LO IN 'fills,-PLAT IS FOR IDENTIFICATION PURPOSES ONLY AND DOES LM CONSTITUTE A PROPERTY°SURVEY AUG 1 21997 o 17 07 8511, !ras PECTiMS # s'r'0�2Ttfittri TG?t.��i.i c�r�� JUN 2 4 X998 T I,+ �-1 I -- VZ b 27 o ' 1 + t. o FORCN P9-6PaSIn 1 SID P'\/ Ol WIF HOUSE Id'± VT. I wvc 2:7+ Lt N� 106 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.