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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. ���o - (� �, Alterations
NORTHAMPTON, MASS. S�� 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location 2 5 5TI'A-t�1 1` Lot No.
2. Owner's name Address Sal--e--
3. Builder's name 5 e, Address 5 �--
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration SIT t7tk�t�11 C�UKfIO� - PrTfPrLttF� 1-f
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- Cjz J
The undersigned certifies at the above statements are we to the best of his.
knowledge and belief.
Signat rt jresponsi nppicant
Remarks
LcaCHIMNEY0
Ll
DW
1
I
I_
�O
va 30" WIDE
omwo
KITCHEN RENOVATIONS
x - , EDY AMBROZ RESIDENCE
125 STRAW AVENUE
FLORENCE, MA 01062
�^
-5 586-1086
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MAY
OF
rasa
"' m TMENT OF BUILDING INSPECTIONS _
INSPECT NO�QdFBUhLDiNG 1NSPECTIgNS 12 Main Street • Municipal Building '>a
RTHpMpI.ON MA 01t?6Q �"
f Northampton, MA 01060
Applicant Information
Name ----------
Location ------------
City--- — � '�� ------------------
I am a homeowner performing all work myself
°I am a sole proprietor and have no one working in any capacity
❑ I am an employer providing workers'compensation for my employees working on this job.
Company Name ------------_------ --
Address
City-- -------- ----- Phone#--------
Insurance Co.------------ ---
Company Name
Address
City Phone#
Insurance Co. Policy#
Failure to secure coverage as required under Section 25 A of lvlGL 152 can lead to the imposition of criminal
penalties of a fine up to$1500.00andfor 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 maybe
forwarded to the Office of tigati ns of the DlAfor coverage verification.
I do hereby certify under th p irs a d penalties of perjury that the information provided ab ve is true and correct.
Signature Date �r
Print Name Phoney
Official Use Only Do not write in this area to be completed by city or town official
City or Town PermitfLicense f ❑ 5-UM Dept
❑
Check if immediate response is required Lrensing Board
Selectmen'Dept.
Contact Person Phone# El
Healtk Dept.
ItAM
of Partila11 ptall
DEPARTMENT OF BUILDING INSPECTIONS
INSPE TC r
OFSUtLI)!yGIkSPECTIOPv 212 Alain Street ' Municipal Building '
1 11
O Northampton, Mass. OlOGO
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE:
JOB LOCATION: V}
(Map) (Parcel) ( Subdivision)
HOMEOWNER: tD11Wr FJ, I PM1 J'U'Z (ZS --,TV rw A—)�--
(Name & Address)
56b i�
0
(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 persons ) 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 ' ng Laws, and State of Massachusetts
General Laws Annotated.
HOMEOWNER SIGNATURE
BUILDING PERMIT #_ V,/
10 Do any signs exist on the property? YES NO � +►3
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 column to b8 filled in
by the Building Department
Required I
Existing Proposed By Zoning
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
#
of Loading Docks
Fill:
-(volume -& location)
13 . Certification: I hereby certify that the inform ion contained herein
(, is true an accurate to the best of my knowled
DATE: - �j �� �� APPLICANT's SIGNATURE
NOTE: Issuano a zoning permit does not (relieve an applioan a b rpen t oomply with all
Czoning requlrements and obtain all required permits from the Board of Heal h. Conservation
ommission. Department of Publio Works and other applioable per it gran ng authorities.
FILE I
MAY 71994 '
DEPT OF$t1ILDlNG INSPECTIONS File No.
NO 50 I
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: cl Tlfik I"� �h1(�R�Z
Address: 11-S Sr' IASV - _r_Gf,DRMIky P Telephone: 1;9)
2. Owner of Property: e"e__�
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: (12 S ST(',/�W fKV-L UDfL6 UC
Parcel Id: Zoning Ma p# / Parcel# 7 District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5, Existing Use of Structure/Property St WIT FAKIWI WIDWCL
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
KCa j,1— IJ_ ntIFc-CIn�J ; 1 �i.1 t�r�21 ► (� Qt J?Lw (mil
kyjsuUPj)o�
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.
S. Has a Special PermitA/ariance/Finding ever been issued for/on the site?
NO DON'T KNOW YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW_ G YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO 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-1999-0928
APPLICANT/CONTACT PERSON GERSHUNY LISA GALE&EDYTHE M AMBROZ
ADDRESS/PHONE 125 STRAW AVE 586-1086
PROPERTY LOCATION 125 STRAW AVE
MAP 17D PARCEL 017 ZONE URB/WP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildma Permi Filled out
Fee Paid I �
Typeof Construction: REMODEL KITCHEN,NEW FLOORING,GYPSUM BOARD,INSULATION,FIXTURES,
HEATING,ELECTRICAL
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THEOLLOWING 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 Officl4r 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.
125 STRAW AVE BP-1999-0928
GIS#: COMMONWEALTH OF MASSACHUSETTS
MW:Block: 17D-017 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-1999-0928
Project# JS-1999-1546
Est. Cost: $5000.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin
Lot Size(sq. ft.): 19994.04 Owner: GERSHUNY LISA GALE&EDYTHE M
Zoning:URB/WP Applicant._
AL.--1 2LSTRAW AVE
Applicant Address: Phone: Insurance:
ISSUED ON.•511011999 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL KITCHEN,NEW FLOORING,GYPSUM
BOARD,INSULATION, FIXTURES, HEATING, ELECTRICAL
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 5/10/1999 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
aCity of Northampton
BUILDING INSPECTION LABEL
PL F30 F�20V E n
� aL)Inspector
Date {
125 STRAW AVE BP-1999-0928
GIS#: COMMONWEALTH OF MASSACHUSETTS
Maw lock: 17D-017 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-1999-0928
Proiect# JS-1999-1546
Est. Cost: $5000.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: .
Lot Size(sa ft.): 19994 04 Owner: GERSHUNY LISA GALE&EDYTHE M
Zoning:URl3/WP <1 nplicant._
AT• 125 STRAWA VE
Applicant Address: Phone: Insurance:
ISSUED ON.511 011 999 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL KITCHEN,NEW FLOORING,GYPSUM
BOARD,INSULATION, FIXTURES, HEATING, ELECTRICAL & bathroom 3/3/00 EJi%!z
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: -/��J�%��� 1' Rouse# Foundation:
Final: Final:
Rough Frame:
Gas Fire Department Fireplace/Chimney:
Rough: ^il• Insulation-O
Final: 11-'7' 01
✓��►�'✓
Final: Smoke:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTI r1CN VIOLATION OF
ANY OF ITS RULES AND REGUL ION
Certificate-of an signature: �
Fee Type: Receipt No: Date Paid: Check No: Amount:
3/3/00 1737 $25.00
Building 5/10/1999 0:00:00 $40.00
212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo