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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
a NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
C C J Garage
1. Location G 5 N c�-11 1�� �C o l p�- <)--,C, / _' / Lot No. p
2. Owner's name r3 i/'(�'� 14 7 0A":< ,(. Address U 1 A,,- c, '
3. Builder's name / t4 S 1 art �, Address 60/'-
Mass.Construction Supervisor's License No. Expiratioj Date
4. Addition
5. Alteration -z id ",q e, ,_
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 r
11. Distance to lot lines f� '
12. Type of roof >a1d'�
13. Siding house A,1
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
� n
Signawr�of responsible app,icant
Remarks
0/t
�0 0/9"aw
William F.Weld /�nac Jtcate
Governor one - Room 0'
Kentaro Tsutstimt" � MGCon, / aclEuaelts 0,2708
Chairman
(617) 727-3200
Charles J. Dlnezl0 - SOLID FUEL BURNING PELLET STOVE AFFIDAVIT
Administrator' •=" -_..e ..�— _ +t:
FOR PELLET STOVES SATISFYING-"NEGATIVE PRESSURE"TESTING `Y
To the State Board of Building Regulations and Standards: Date 8-25 1993
1, Drew McDaniel as National Sales Manager
on behalf of Pyro Industries , Inc.
a manufacturer of solid fuel burning pellet stoves/heaters/fire place inserts(circle appropriate products),
hereby certify that the following pellet heating a liances,_ by explicit model Identification;
model(s): WN uest Freestanding•\and Insert
have been tested,o tested listed circle appropriate information)per the"negative pressure"test requirements
of either ULC S627/CSA Standard B366.2,or draft standard AS'IM E-91,revised draft 5/28/91,and found to
satisfy the applicable criteria of ULC 5627/CSA Standard 8366.2 or draft standard ASTM E-91,revised
draft 5R8N];additionally,burnback did not occur either during normal or abnormal"negative pressure"testing.
MANUFACTURER: Pyro Industries , Inc.
SIGNED:
TYPED OR PRINT NA-MEABOVE: Andrew K. McDaniel
TITLE: 14atioual Sales Manager
On this day of. ,1911,then personally appeared before me,the
above named _ �/ A it 4,)
and made oath that the above statements by him/her,are true. _ MARSCEIA V. VALDIVA
NftfY FLble
STATE OF WASHMTON
BEFORE ME My Commdskn En*es
• U oaf*W 29. 1993
NOTAR PUBLIC
MY COM6IISSION EXPIRES: g/ 19f_
ne6Pre.t.91 Page 2 of 2
•=o4ct+MtPTO
e Gl its Jaf wort 11aill Mall
�RS6 ACI�lI BfIIS
DEPARTMENT OF BUILDITjG INSPECTIONS
INSPECTOR 212 Alain Street ' Municipal Building
Northampton, Mass. 01060 4 `
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE:
JOB LOCATION-
(map) P �ekn) (subdivision)
HOMEOWNER:- �---
N e Ad ssk� _ \
7 \ J
(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 SIGNATURE
BUILDING PERMIT #
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 color to be filled i,
by the Building Department
Required
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
frof Loading Docks
Fill:
_(vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
�f is true and accurate to the best of my knowledge.
DATE: li APPLICANT's SIGNATURE
NOTE: 1ssun1IW-a'i6f a zoning permit does not relieve an 1 ant's �ue�n t comply with .ali
zoning requirements and obtain all required permits fro the Boar He h, Conservatio
Commission, Department of Publio Works and other applionble per gra t ng authorities.
„ FILE #
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: �nl<`
J J
Address: �� �� !L t l( %�- Telephone:_- 5g- V-
2. Owner of Property: (, I'
lr ,P ��0 p
Address: Z� J�4�c�,� c n Tele hone: �S �'��!�
3. Status of Applicant: �/ Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: or;— `
Parcel Id: Zoning Map;'— Parcel#_ - � District(s):
R BD IN BY THE BUILDING DEPARTME
5. Existing Use of Structure/Property ,C�"��,f 0
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 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
4 8
r
APPLICANT/CONTACT PERSON:
ADDRESS/PHONE:
PROPERTY LOCATION: C
MAP_2j PARCEL: d ZONE
THIS SECTION FOR.OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
7.ONTN(T' FORM EM LED OUT
Fee Paid
lRijildinE Permit Filled nvit
r
Arresynry Strnrture
�010rrllpant Statement nr License#
3 Sets of Plans /Pint Plan
THE FOLLOWING 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-Bd of Health Well Water Potability-Bd Health
Permit from Conservation Co ission
Signature of Bu i g ecto Date
NOTE:Issuanoe of a zoning permit does not relieve an appiioant's burden to oomply with all
_ zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applionble permit granting authorities. _
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