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10 Do any signs exist on the property/? YES NO A_
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 colu= to be filled in
by the Building Department
Required
f _ Existing Proposed By Zoning
Lot size
Frontage C)00 c�p C) c' l j
Setbacks - frnnt
- side L: IaQ R: lay L: 1�0 R: I30 A5
- rear ao a Q
Building height � ' S
Bldg Square footage
►-c —�
%Open Space: rasa.%
(Lot area minus bldg
&paved Fay i:Lngi
# of Parking Spaces
# of Loading Docks
Fill:
-(volume -& location)
13 . Certification: I hereby certify that the information contained herein
_a
is true and accurate to the best of my knowledge.
DATE: �'��/ t� APPLICANT's SIGNATURE
NOTE: Issuanoe of a zoning permit does not relieve an app 10anva lAunden to oomply with all
zoning requirements and obtain all required permits from the Board of Health. Conservotion
Commission, Department of Publio Works and other mpplioable permit granting authorities.
FILE #
JIN File No. J617 t
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: S 14FIPcrn1
Address: 117V R-3) Telephone: ? —
2. Owner of Property: M1`fe 6, sf}fl2-f'r'
Address: g t� ) C-1.1i 1lyc lu Telephone: i Y -7 t J .5
3. Status of Applicant: Owner _Contract Purchaser Lessee
Other(explain):
4. Job Location: "al
Parcel Id: Zoning Map# &� Parcel# District(s):,�S/Q—
(TO BE FILLED IN BY THE BUILDING DEPARTMENT
5. Existing Use of Structure/Property GijZ ` �XC
6. Description of Proposed Use/Work/Project/Occupabon: (Use additional sheets if necessary):
T fRA J�cuW (2) c-LD WtP.5 PUT i'P (1) 10 X, 1'l SH£17
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.
S. 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-1_ 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)
0 4 �sinxctttisctln M �
JAN Z i999EPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
` DATE
JOB LOCATION:
(Map) (Parcel) ( Subdivision)
-
HOMEOWNER: Mtbz 4 A- S am -- -- —
(Name & Address )
&1 FLT P1 r_o rK A-. 0 - - - ) SS-
( 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. o
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
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9 6 AX21%xChn5r1ta
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m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFYIDAVYF
(li censeci permi ttec)
with a principal place of busuiess/resldence at:
(strcet/c.ty!s catelzi p)
do hereby certify, under the pains and penalties of penury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on tliis job:
(Insurance Company) (Policy Number) (Expiration Date)
O 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:
Of COn[I CtOf) - (1;1Sll!:.[lC �,OtIlj:31 j';Pi1i1C=f ? 1IIl''Ci) (E'x)IE tmpi Date)
(Name of Coil[I�.C'Or) (ijlsura_acc tornT auv/E'ot gate)
(Name of Coar-actor) (Instifancc Company/Potic; Numlxr) (-Expiration Date)
(Name of Contractor) (Insurance Company/Policy Nmllbe10 (Expli-a ion Date)
(ntladr ad�i$ccil lhcct if ncYn ry to icxluck iafcraiidoo patuaing to all� 'x radon)
( ) I am a Sole proprietor and have no one working for me.
( I am a home owner performing all the work myself.
NOTE-plcnac be aw-jrc that whi]o hcmco%y,_,vyt)o employ perioar to do iu nc� aonz7vdion u ids Mork ou a dwelling of
not mo%-thw than traits in which the hoax myncr r=c n,m the Wouad3 appurtenant th,, t arc oot gcncrall f co(mckrcd to be
employes under tba worlcr_ts.00mpcns ca Ali(C3L152,=1(5)�application by a homeowner Car a lira=et p=mii may cvidcnoc the
Itp]ambis of an employor candor tho Workoes c6av<WLLion AL(_
I undcrztt d chit a copy of this rzat.cmcni a y bo forw-ardod to rho Dcpartm A of InaL&ria1 Ac idk ir'BOO of In�ir.nco for tbn
cowls ge verifiealioo and that Ei tre to somm oovcrnlro un&r section 25A of MCIL 152 can lead to tba imposdtoa of criminal peaaltics
eoatistittg of a fine of up to S1,500.00 ar"Nor impruo� of up to OUC year end cavil pcnaltia io the form of a Stop Work Order and a
fit:a 0f:3100_00 I day against Cy-
Fcc dcFutur�l Wo only
n Permit Number -
' Map# --Lot# 41 'Z.__
-DRe
Sigz aturc of Li MscclPc:miticc --- L
FILE
r
JUN 2 Eye
APPLICANT/CONTACT PERSON:
ADDRESS/PHONE:
PROPERTY LOCATION: 9 t -�r
MAP PARCEL: (Q `� ZONE
THIS SECTION FOR-:OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM MLED 0111
Fee Pnid
r
AcreSSnrV Strnrtnrf.
TBE,FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
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:
Water Availability Sewer Availability
w?t,:
q pp . 1< it d'of Health Well Water Potability-Bd Health
„j,F'lrmi �rn.CyMs io ssion
Signature of Buil ector b e
NOTE:lssuanoe of in 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 applioable permit granting authoritles.
C 071 -�
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. �� l Alterations
NORTHAMPTON, MASS. a-)nli , 19111 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location S E) 9�-'` JJL' 2 Lot No.
2. Owner's name MK ?`} Address ) @-
3. Builder's name M y K J1 , Sl'}r-I cyj Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
�'T r A)is W, %V 5#0>
5. Alteration Q L �' /G� X
6. New Porch
7. Is existing building to be demolished? S 779K£ `)OX#w 1 C�� 1 X 1S 7A,5 64PGS
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Ua
-T Signature of responsible app,ican!
Remarks FR+ « ��`x 1y SH�� T1 "ffPT fl �2•"t7" ;7C7a:� 3�� Uan PLY f2c
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