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Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. .1 ��� Alterations
NORTHAMPTON, MASS. ( /� 19 Additions ✓
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location Lot No.
2. Owner's name CAD( Address = dx�s
3. Builder's name Address Y `
Mass.Construction Seuupeerrv,ssor's License No Expiration Date
4. Addition
5. Alteration
6. New Porch
7. Is existing building to be demolished? 4it� LS wmr'Q
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating— N A
11. Distance to lot lines
12. Type of roof 0-5
13. Siding house X
14. Estimated cost:-
✓ � �h ��� The undersigned certifies that he above statements are we to the best of his, her
f •i knowledge and belief.
Signature of respo4tl appicant
Remarks
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Q DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Strect ' Municipal Building '
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
DATE:
( Please Print )
/U�rYI U�
3J
JOB LOCATION: r
(M ( Parcel ) ( Subdivision)
HOMEOWNER:
(N & Address )
( Home P (Mork Phone )
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one ( 1 )or t•.m (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 #
4�tt�rpr
azo °a Grit r Of 'Naz#ilalltpfnll
8 a OCT =aaRrl(DSrtte
- DEPARTMENT OF BUILDWG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER' COMPENSATION INSURANCE AFFIDAVIT
(liccnsecJpermi ttce)
Nvith a principal place of business/residence at:
-(Phone#)
(strcet/city/stainer p)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Dace)
( ) 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/Policy Number) (Expim6oa Date)
(Name of Contractor) (Insurance CompamvPolicy Number) (Expiration Date)
f
(Name of Contractor) (Insuran(::. Company/Poucy Number) (Expiration Date)
(Name of Contractor) (Insurance Companyll olicy Number) (Expiration Date)
(attach additional shed if necessary to iod-le iafbr n ion pertaining to all cc-`crt adorn)
i
( ) I am a sole proprietor and have no one working for me.
4 1 am a home owner performing all the work-myself.
NOTE:please be aware that whilo homcown=wbo employ pazom to do maincaaneS mn4ructiao or tc{xiiz work ao a dwelling of
not ntoec than tbreo units in which the bomeowncr raide3 or on the grounds aptxrrteuartt thereto arc Dot ecoa-2ny comuiard to be
cmployrn under the"^nicer=ccc ton Ad(GL152,n l(5)),application by a homeowner fat a Ucc=or permit may cvidcooe the
legal clatus of an ernployoc under tho WOrirCra Comp<mation Ad_
I understand that a copy of thin csatemm2 may bo forwarded to tho Dcpartmmt of Industrial Ac idea&01E00 of Invminco for the
oovaagc vaificatioa aad that failure to accure covrrabo undcr scctioa 25A of MOL 152 can Icad to tbo imposition of criminal peaaltiea
comiating of a fmc of up to S 1,500.00 and/or imtuisoDmcni of up to one year and civi pmattics in the form of a Stop Work Order and a
frno 0(5 100.00 a day agaiwl me
All
Signed this , _day of ( 1997 For dcpct=tAl uao only
Permit Number
/ Map# Lot#
Signature iansecJPc tt
r
10. Do any signs exist on the property? YES NO
yr,
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 cclu= to be filled in
by the Building Dbpartm nt
Required
Existing Proposed By Zoning
Lot size 43 6X� 0,6
Frontage
Setbacks - f
- side L: CR: _ L: R: IL() 16
- rear
Building height �' C
Bldg Square footage
do
%Open Space: _
(Lot area minus bldg 0
&paved parking)
# pf Parking spaces �-
# of Loading Docks
Fill:
4 volume -& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my L knowle e.
DATE: /b//����7 APPLICANT's SIGNATURE
NOTE: luauano46 of a zoning permit does not relieve an app ioant's b n to comply wit4 oil
zoning requirements and obtain all required permits from the Board CW Health, Conservtstion
Commisslon, Department of Publio Works and other applicable permit granting authorities.
FILE #
.Rw
4 � File No.
j
E ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: &.( OR�'E Address: 't-�ST) Telephone:
N
2. Owner of Property:
IIQ-
Address: Telephone:
3. Status of Applicant: V/ Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: nn
Parcel Id: Zoning Map# Parcel# ff�� District(s):�!3k
(TO BE FILLED IN BY TH UILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
`L
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 PP
IF YES, has a permit been or need to be obtained from the Conservation Commission? 5h d u>>�t y-
Needs to be obtained Obtained ,date issued: (06 �t?�
(FORM CONTINUES ON OTHER SIDE)
962995
FILE # 160
y
3 2
APPLICANT/CON*ACT PERSON: ),502
ADDRI✓SS/PHONE:
PROPERTY LOCATION: o I .4� 7n4 A&t
MAP ;33- PARCEL: ZONE,
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM EMLED OUT L7_
Fee Pnid
Adffitinn to Existing
mod- ✓
1/
THE TefLOWING 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
Per ' from Cpnsery o i i
Signature of Building Inspector Date
NOTE:Issuance of a 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, Departmant of Public Works and other applicable permit.granting authorities.
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