29-451 (10) b
z
Po * o Z o .7-ti 2 b 4. �'3 o v, a 1Ee ti0tA
1--1 ..
I §:g E R p i. p, e,-. 6 , . „,,, 2,
0
o c' C� o ° g (,,, a ~3 1°tv
a °� '4 o n S.
� v
: fl & y 0) ,. "3
o a £ I�■I'
,y o 5 " s °, ob •0 r 0 w
rini
,::, ..„.g ° v, gtg9n' g' n 0 n. ._.•
,.fit ' $ o � (D n � �""'g: b....y �' 0 Q!,.
rt CD
� `Z t ,- 0
rri
< o 411)
`cam_ ao �. ��, �"' � 5 ~ �'
5c = F' ° ocog w z
2 1 .8 . 4. t � n
ti o
° Ago.
4111111111) CM
CA cn
y �
o oo
(,)
\ . 0 5 5 5
tilt
Pilliii, cp. ,,,,„
CD .
/1 .n-. CT. a °
til \ OM cin =.., c4,, 5 ,..., 0
a ,, 5 5: Q m wN r0 ril
ell° a
cra
5 ‘tt '
o -° T y a a ` ac (/p
I E. .
o ;1-1. o ....71 o CD„ n
�' o o g b a• tTI
` CD ' ° c' ° o' c' ° a 5 o a
d g ` \ o aro c vo C
P I go. g .to 2 E cn2
., = ° c a o a• a- O rn o
C)
h
rri
CID p' t) y
° rn 5
'0 CA
C)
e)
CD
FILE I L # 3 •1,
lift
it 3 199 ‘5,39--,
APPLICANT/CONTACT PERSON: It ,,,,e2 LgT - I _ 3
ADDRESS/PHON4:
PROPERTY CATION: L 3' e i - - '` /)-%4'
MAP p PARCEL: ZONE,,4041_447-
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CFIF,CKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FITTED OTIT
Fee Paid
2 Building Permit Filled not ./.–Fee Pahl ;7_7&� 'c
Type nf! 'nnctnictionv
New ('nnctrnctinn /j1 � ;cj, V
Remodeling Interior ,
Addition to F Yicting L y,0 / 24 �t�j",7 /L
Aeeeccnry Structure U
Riiildi • '-lapc Included!
S . . e . . s . • n • . I • •
3 Sets nf Plans /Pint Plan
THEIL IN
LOWG ACTION HAS BEEN TAKEN ON THIS APPLICATION: i'
�1//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-Bd of Health Well Water Potability-Bd Health
!Permit from Conservati oesm.- -:
,0•7"'° ,. /$ri". j- 9,
Signature of Building or Date
NOTE:Issuanoe of a zoning permit does not relieve an applioant's burden to comply with all
_ zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
i
4
Jai 23 111111 r
File No.�/p� ��
;ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:_`
Address: 02 C'/P�S 7 /(� Lt/ Telephone:
2. Owner of Property: Ftt<',/4//A P/c/52,24
Address: 3,72-- c-/C E ST V f E V/ 9,C. Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: _
Parcel Id: Zoning Map# p Parcel# 44'57 District(s): G/a 3
(TO BE FILLED IN BY THE BUILDING DEPARTMENT
5. Existing Use of Structure/Property _446•7162-4YUSLy
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): •
5 /7 -c////// -2__E•c
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 PermitNariance/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 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)
1
at 11 9
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. Att INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This cols to be filled in
Yv
` I /_-::2 by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks -frnnt _
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
of -Parking Spaces
ro
p f Loading Docks
Fill:
(vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
DATE: Z-,..,13X 7 APPLICANT'S SIGNATURE NOTE: Ise noe of a zoning permit does not relieve en applioanes burden to comply with,all wN
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Pubilo Works and other applioable permit granting authorities.- *
FILE #
11nM PT
e'altgoe °I,
F��'�� w ��« Aesaacltuertla OHO- al NOrtilnillPtan
nroMtro
ERR -Eaff
emu+`'• ' DEPARTMENT OF BUILDING INSPECTIONS ,
1_,...v.r
I
INSPECTOR - 272 Main Street ' Municipal Building
Northampton, Mass. 01060 �'
HOMEOWNER LICENSE EXEMPTION
�-�� ( Please Print )
DATE: —
JOB LOCATION: d(ii– •$4/5-7 -- ilA eila7Q13 41'
(Map) ( Parcel ) ( Subdivision)
HOMEOWNER: FM/t/A PA--/ A4' 9
�� rW�s TYE W p A,
(Name /CG o R 5i(/CE c-84` O 4,:43-
,
( 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 .
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 Annotated_ t
HOMEOWNER SIGNATURE
BUILDING PERMIT ##
t .
071).
Afi'
. ,
��.OAT 11^1-1 P�.0) _
i,c� o#moo
9 A t fl -�x of Ntttfl &nt toil 1 ---.
9.%4110.4"1"IB asaachnsctia _=-4:41.: -
IMP"a =z :
-"� AR NT OF BUILDING INSPECTIONS _;_
-.. .21Mai' Street • Municipal Building
''`' P�NS\lo thampton, Mass. 01060 tr'°
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, � > 1A/ e/C42V
(li censer/permi ttec) .
with a principal place of business/residence at: 40
3''C 'C.STV/£W M (GD ,VCE (74 O/Of ne't)- .-8'4`6'61,23
(stref_t/ci ty/statehi p)
do hereby certif , under the pains and penalties of perjury, th r.
( ) I am an employer providing the following worker's compensation coverage for my
employees worng on this job:
(Insurance Company) (Policy Number) (Expiration Darr)
( ) 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/Poticy Number) (E.xpiration Date)
(Name of Contractor) (Insurance CompamiPolicy Number) (Expiration Date) ,
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additiooal swot ifnocemary to include infocrnatioo pertaining to all cocoa-odors)
I am a sole proprietor and have no one working for me.
2K I am a home owner performing all the work myself.
NOTE:please be aware that while homcowocrs who employ persona to do ma rrtrn ,coastruntioct or repair work on a dwelling of
not morn than throe units in which the homeowner traidr3 or on the pound,appurtenant thereto arc not gccerally ooasidcrrd to be
employers under the worker's CCIIIperasslicci Act(GL152,=1(S)),application by a.homeowner for a titters or permit may evidence the
legal status of an employer under the,Worker's Cocopocciation Act.
I understand that a copy of this ccatemmi may bo torwnrdad to the Dcpoctaaccd of Industrial Accidra •Ofrioo of Inoximooa for thn
nova-age verification and that failure to secure coveago under section 23A of MOL 152 can lead to the imposition of criminal penalties
i .. comi.saug of a fine of up to S1,500.00 and/or imprison of up to one year and civil penalties in she form of a Stop Work Order and a
fins oC5100.00 a day against me.
Signed this eX-3 day of T 0/V 199 7 For depart:modal use only
Pciuut Number
� t-2-,2 Map# Lot#
Signature of L1crensee1Pcrmittcr
gesso.
)1‘
4,.. e
, > ,
., ,
...
, ,5 ..
, , 7,.
, .
T
v -J c
o .2' eri
4 —,
.... ,
o n O
Z v
...,
r -3 m
tit C x
c
Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. S—,-9.0001.. Alterations
'•-%r. NORTHAMPTON, MASS. tro7 " -.2_.g 19 '7 Additions
W.I. 1 APPLICATION FOR PERMIT TO ALTER Repair ieOC e •
4' Garage
1. Location J CR&5 V/E h I L)i f 1oRE,v c E 0.4) 0/06.2, Lot No.
2. Owner's name F 44l/c P/C/L 'D Address J.Z.- e-,PtT57`t/4i-v p,P FL OfeEA/cE /-`v
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
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 ..17/(4/6-4- E.
13. Siding house
14. Estimated cost-(eft:5--e
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
4
-,
Signature of responsible appLcant
•marks S`i'//1/G--L E. 0 V t t2 ,S' / /VC-L z_4)'E,e o' s.///�I%`‘L C.S'
a.*
-
fr
t
Cr)
g
4
__....__. ....,w„