29-252 FEB 18 ;998
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
a APPLICATION FOR PERMIT TO ALTER Repair Z/11
Garage
1. Location S9 We U✓12,fj- 17 14J ClMcl 014,- 0/0 6'0 Lot No.
2. Owner's name JMP Zr'I�✓n/E �A ��S Address 1071146,
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition G
5. Alteration Alj
6. New Porch iG 6
7. Is existing building to be demolished? /VG
8. Repair after the fire , 1
9. Garage_ No.of cars Size --'
10. Method of heating QQ S-//16rCC C1 AD—/ a i v- CA Q AC JW i.J /'yc,i t
11. Distance to lot lines
12. Type of roofla�c��l/
13. Siding house " %��T �h�vGa/i �/Lc (X7/C'viCr r,✓cty� -�r� c� lJ
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
signa,ttureo responsible app,icant
i
Remarks C' k�J>/n�t3� wel/ ,�v� �`�J G,lt J-eCdw(--' 4oG✓' rj- -,/e, 6C ,/,,e,�me V(C/ ;,.�
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$ FEB 6 1998 ' ° Crzt� of Nart4ampto t ^_
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
S1,;M91 , ,(,JF►/2/ `f" J-u 2. o"/1J e, ('.
(lic=see permittee)
with a principal place of business/residence at:
o/6 6'; (phone#)
(streei/city/sta&2:ip)
do hereby certify, under the pains and penalties of pedury, that:
( ) I am. an employer providing the following worker's compensation coverage for my
employees working on this job:
1 (Insurance Company) (Policy Number) (Expirat on Date)
1 so e proprietor, g contract
r r hom er circle one) and have hired
the contract'o s`llsted be �v ho have the fo owing woe eery compiMnsation policies:
6kk-
(Name of Contractor) (Insurance Compary/Policy Number) (E)piration 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 additioml sheet ifneocnary to include information pertaining to all ooatradors)
( ) I am a sole proprietor and have no one working for me.
---
P`A Y'X I am a home owner performing all the work myself.
NOTE:please be aware that while homeowners who employ persons to do mainteaaace,eomvction or repair work on a dwelling of
not atom than throe uatu in which the homeowner resides or on the grouads appurtenant thereto arc not generally 000ndercd to be
employers under the worua's compensation Act(GL152,ss 1(5))r application by a homeowner for a license or permit may evidence tho
legal statue of an employer under the Workers Compensation ALL
I undersund that a oopy of thin cutement may be forwarded to tho Depnrtasm2 of Industrial Axiderrts Offroe of Insurance for the
coverage verification and that failure to seater coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to$1,500.00 and/or imptisomnerd of up to one year and civil penalties in the form of a Stop Work Order and a
frno of 5100.00 a day against me
" � For te—o
,j� _ ,/ Permit Number
�— ni�-"� y / �S Iviap# Lot#
Si of Licimsee/Permittee
Oq�VtMp \
of 'Norf4alllptatt
IM
� 9 �laaaacltuaetta
FEB 6 11998 DEA,AtTMENT OF BUILDING INSPECTIONS -
INSPECTOR 212 Main Street ' Municipal Building '
M )6`
n Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE: le_6
JOB LOCATION: J'-/c G✓ic�i�a.1T r7 /v ✓1✓Z7d r 0/00
(Map) (Parcel) ( Subdivision)
HOMEOWNER:7jdpH,')J c/ V A9t 1Str Z4 ivry e C. Pa l•.1,r<'AJ1
(Name'& Address )
_}/Y- _F�-X�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 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 1
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 X
IF YES,describe size,type and location:
11 . ALL INFORMATION MUST BE COMPLE'T'ED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This co2umm to be f121ed iII
a, 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
&p_aved parking)
# of -Parking Spaces
ht of Loading Docks
Fill:
-(volume -& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: ,� �!� APPLICANT's SIGNATU n tvNOTE: Is uanoe of a zoning permit does not relieve an applioant's burden " mpty wit4'oll
zoning requirements and obtain all required permits from the Board of He h. Conservation
Commission. Department of Publio Works and other applicable permit granting authorities.
FILE #
i FEB 6 ;998
File No. 7d
.�.��.....�,,.�....._. :. OING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: ;/Ory�)S 64,4 7 -7i' C, PC:21; .MtF
Address: ,SI 572 �T Telephone: �Lz
iUcT�Jdv�1, r�T0�J1 /,'i e9 o
2. Owner of Property: sAr rt K'J A4 J v[`
Address: '7c Telephone: j_4^16
3. Status of Applicant: ,Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# Parcel# 191 District(s):_ le�12 C�
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property .4&1-I E �_
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— X 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_7X/_ 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)
• j
9 FILE # 963203
�7
FEB 6 i998
� +'> ? j1APPLICANT/C Q N TACT PERSON:
ADDRESS/PHONE,
PROPERTY LOCATION:
MAP C_ PARCEL:
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FULET) OUT
Fee PAid
Fee Pgid le Le
Addition t�Existin2 ✓,
,f
J
TIT OLLOWING ACTION HAS BEEN TAKEN ON THIS APfEICATION. k
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: § iv/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 Commission
q
Signature of—Buildirff Inspecto Date
NOTE:Issuance of at zoning permit does not relieve an applicant's burden to comply with all
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission. Department of Public, Works and other applicable permit granting authorities.
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