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29-057 (2) > LO) Z Z a A Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations aNORTHAMPTON, MASS. 19 Additions APPLICATION FOR PERMIT TO ALTER Repair l Garage 1. Location Ge Lot No. 2. Owner's name ` / '� Address,G 3. Builder's name Address Mass.Construction Supervisor's License No. Expiration Date 4. Addition 5. Alteration 42f, 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 11. Distance to lot lines 12. Type of roof : 13. Siding house fi�r// 14. Estimated cosk-9, i The undersigned certifies that the above statements are we to the best of his, her knowled / Signature of responsible appicant Remarks �O��1lAA!p�Oy OCT � �d56ACI)IIH t))H lye l DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR ' 212 Main Strect ' Municipal Building ' Northampton, Mass. 01060 �~ HOMEOWNER LICENSE EXEMPTION ( Please Print) DATE; JOB LOCATION: ( Map) ( Parcel ) ( Subdivision) HOMEOWNER:_,�, �- - t (Dame & Address ) ( Home Phone ) (Work Phone ) The current exemption for "homeowners" was extended to include Owner-occupied Dwellings of one ( 1 )or ti•m (2) fami 1 ieS 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 f /� BUILDING PERMIT 0 a 'µ Crzf of Paz#f�ttlit�xait Jffi yl 0a ^ Ozaaschnsctte m DEPARTMENT OP BUILDrNG INSPECTIONS F - y '-_ 212 Main Street ' Municipal Building 'a „ Northampton, Mass. 01060 WORICER'S COMPENSATION INSURANCE AN MA.VIT (li ccnscrJpermi[tee) with a principal place of business/residence at: (phone#) (stet/city/statr/ap) 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 wor�-dng on this job: (Insurance Company) (Policy Number) (Expiration Date) ( ) 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 Compary/Policy Number) (Expiration Date) (Name of Contractor) Omsumcc ComparlyiPobcy Number) (Expiration Date) f (Name of Contractor) (Insurances Company/70licy Number) (Expiration Date) i (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach addi6ot:W shed if neecstary to include information pertaining to all oo Grad4n) I ( ) a-m a sole proprietor and have no one working for me. (VKam a home owner performing all the work'myself. NOTE:pleaae be aware that whi]o homcowncrn who employ pcfr to do rnairticaa ,C=Structioo or repair work on a dwelling of oat mere than throo tmrts in ttfnic h the 13trnYAWrner m d,=or oa the grounds appurienurt thctrto arc not et:= ly oocsidercd to be employes under the works oaTx—a cn Act(GL152,ss 1(5)),application by a homeowner for a Gc=c or permit may cvidcnoc the legal rtahta of an amployoc under dw Wocicole Compomation Ad I understand th.,t a oopy of thi:rta1cmca2 may bo fontivardcd to tho p,pVwbn at of Indrstrid Acadca&Offioo of Ir>;urwoo for the oovaage vaificstioc aad that kdurc to scats coverago-0cr saxioa 25A of b(OL 152 can lead to tba imposi ion of criminal peaaldes comistiag at a fine of up to S1,300.00 andloc iraprisoamcrd of up to ow).car and av�pcaaltia in the farm of a Stop Work Order and a fine ofS104,00 a lay against UY- Signed this _day of. Z5�7e/7" 1997 FordcpVt=-W eoaly Permit Number Map#_ Lot# tgnabtre of rnuttce T f 10- Do any signs exist on the property? YES NO v TX1 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 colxmm to be filled in 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) # pf -Parking Spaces f of Loading Docks Fill: -(volume--& location) 13 . Certification: I hereby certify that the information contained herein G is true and accurate to the best of my knowled e DATE: ��� APPLICANT's SIGNATU � NOTE: luauanoe of a zoning permit does not relieve a applioan bu den to oompty wit4'all zoning requirements and obtain all required permits from the and of Health. Conservation Commisslon, Department of Publio Works and other mpplioob permit granting authorities. FILE # • 1 OCT 2 01997 File No. ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: ! /- /� r _ Address: /.o -Telephone: 2. Owner of Property: 51;f?! e -- -- Address: Telephone: 3. Status of Applicant: (/ Owner Contract Purchaser Lessee Other(explain): 4. Job Location: � �, /firQe Parcel Id: Zoning Map# C,? Parcel# District(s):A/2& � (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property 6. Description Qf Proposed Use/Work/Project/Occup lion: (Use additional sheets,it necessary): !' t 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 P/ermiitt(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 # 9 6 ?918 k 161c' PPLI T/CONTACT PERSON: ADDRESS/PRONE# PROPER TY LOCATION: -11LLf/ -c' •-`� MAP PARCEL: 7 ZONE THIS SECTION FOR-OFFICIAL USE ONLY: PERNUT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM MINI) OUT Fee plid Fee Paid ,../ i/ v � Addition to Exisfln2 ,���Qrrupant Statement or Lirensf, ;Y THE OLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION: /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 I/ 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 Conservatio mmission 12--11 Signature of Building or Date NOTE:Issuanoe of a zoning permit does not relieve an applioant's burden to oomply with all zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Department of Publio Works and other applioable permit granting authoritles. n � � � z o r � �.r•�. 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