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29-468 (2) D Z C%1 > 0 51 —I > Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MASS. 19 Additions APPLICATION FOR PERMIT TO ALTER Repair Garage 1. Location e IA Lot No. 2. Owner's name Address )acv-,jy- 3. Builder's name Address Mass.Construction Supervisor's License No. Expiration Date 4. Addition 1,4 b 5. Alteration 6. New Porch N'1A 7 .Is existing building to be demolished? 8. Repair after the fire C\0 9. Garage (,\� No.of cars Size 10. Method of heating 11. Distance to lot lines t�, S-V A I 12. Type of roof A ----,\" 13. Siding house k\, -s 14. EsbmatedcosL- The undersigned certifies that the above statements are true to the best of his, her knowledge and belief. Signature of responsible app,icani Remarks— ACWAe- 0k-c: k ryry - E1 �� fii�ttssscFjpsetla ' G : DEPARTMENT OF BUILDIXG INSPECTIONS INSPECTOR 212 Main Street ' Municipal Building Northampton, Mass. 01060 HOMEOWNER LICENSE EXEMPTION (Please Print) DATE: JOB LOCATION: � ,[ (Gz (Map) (Parcel) V ( Subdivision) HOMEOWNER:- Vic'era, C-V <?� (Name & Address) 57G -Y`A T-{ ( 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. HOMEOWNER SIGNATUREa�L� BUILDING PERMIT # �-tti/J�fp�, s Bz° ° APR 2 71,998 _z � Q of 'N11r#4ttntpta1T .. a ,per, ,$l as%xchnscIts �m DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 ,~ WORKER'S COMPENSATION INSURANCE AFFIDAVIT (licenseeJpelmittee) with a principal place of bust e_&Oeslden at: 14 Ij (street 6ty/stalrhip) do hereby certify, under the pains and penalties of perjury, that: ( ) I ari an employer providing the following workers compensation coverage for my employees working on this job: (lase 3nce Company) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, general contractor homeown circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Nusnbcr) (Expiration Date) (Name of Contractor) Company/Policy Number) (LxpLmuou Date) (Name of Contractor) (Insurancti, Compa_my/PoLi-cy Number) (Expiration Date) (Name of Contractor) (Ins=uce CompaiY),/Policy Number) (Expiration Date) (attach addedoaal shoti tfnccc=s y to mchujc infocmitioo pertaiuing to ell a.�raci.ors) ( ) I am a sole proprietor and have no one working for me. (ij I am a home owner performing all the work myself. NOTE:please be aware dw while homcowocrz who employ perions to do nmzcjc court ictioo or rcpaa work on a dwelling of not mgro then thnoo units in which tEe hotpwwncr rrsidcs or ca tb4 gouods aPpurtcaani thrrcto arc no(gcocratly ooasidcrcd to be cmployaa undcr the w%+a'%oompamaum Act(GL152,=I(5))�application by a hotncowvir far a 13—x Peach may cv`do the legit 0izdiw of an omployec candor tho Woricces Compmaatioa Act I undaatand th:t a copy of thu Lzo tcmcat may be forwarded to the Dcpnttmco2 of Industri al Ac &G&Offiioe of'a`r%nco for tho coverage vaification and that failure to secure coverage under wctioa 25A of MOL 152 can lead to tho imposition of criminal pcnaltics oomisfmg of a tine'of up to S1,500.00 wndlor inT isoamCllL of up to one Ycar and civil penalties in the form of a Stop W oric Order and a fino of 5100.00 a day agninsi ae Fr dpszrno � uio oatY 1 Permit Number Da __-- Signah=of LiccnseelPcruiittce 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 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. This columm to be filled in by the Building Department Required Existing Proposed By Zoning Lot size Frontage — C'\o E Setbacks 61c c l - side L:,50' R:, L: - rear Building height Bldg Square footage 3�© %Open Space: (Lot area minus bldg &Paged Dark-n- # of -Parking Spaces #t of Loading Docks Fill: -(volume -& location) iACd C- 13 . Certification: I hereby certify that the information contained herein G is true and accurate to the best of my knowledge. DATE: APPLICANT's SIGNATURE 1,,LJ NOTE: lasunnoa of a zoning permit does not relieve an applicant's burden to oompty With all zoning requiremants and obtain all required permits from the Board of Health, Conservation iCommisslon, Department of Publio Works and other applioable permit granting authorities. FILE # ppR 2 7 1998 File No. 6Ay 1 ZONING PERMIT APPLICATION (§10 . 2 PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: �)CO'Ao. E. Mc,, Address: c:� V�c>reticcti Telephone: 2. Owner of Property: Address: Telephone: 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): 4. Job Location: Parcel Id: Zoning Map# 07 Parcel# er District(s): (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property �`j 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): ck 7. Attached Plans: Sketch Plan Site Plan f 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 Permit/Variance/Finding ever been issued for/on the site? NO f DON'T KNC%A: 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) FILE # q f-' `? 5 _� V 2 � , APPLICANT/CONTACT PERSON-�� jFVF ADDRESS/PHONE: PROPERTY LOCATION: MAP PARCEL: ZO &_j1d THIS SECTION FOR-OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM EMILED OITT Fee Pnid ]Rnilding Permit Filled nut Fee Paw /W New Cnngtriietin ernndelin2 Interior Addition ti�Existin2 r f T OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION' Approved as presentedfbased 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 RV.. SeticApproval-Bd of Health Well Water Potability-Bd Health Permit from Conservation mmission Signature of Building or Date NOTE:tusuanoa of a zoning permit does not relieve an applicant's burden to comply with all _ zoning requirements and obtain ail required permits from the Board of Health, Conservation Commission. Department of Public Works and other applicable permit granting authorities. open �i cro �d'r•�'ti CD '"� ono R, o o o o �� b n CA CA ML coo n �� 0c) cv a Fv C) o w o 00 rob p o R £ N ,� p a oat ° ::I m cn ( 1 �-i O D O p Qj H b co ��y cwt = v F-H. Mir• a C:L cr y rt o O F'°B °� �s ° !� � d n CD F-3 Fg ° o tz O � � Z r boo Or n 0 O Uq p D p' p N IQ W p ►d m VJ J \ O N 0 E. R. o :C fin a CD �-y y I I I � I I O g• N O O h.� O p o oTl o o o o , o d o o ac w ao o cn va o c• �„ CD tz R-. °a C7 CA * o a n