29-070 (2) L2I CA�
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.� yl�L�7 Alterations
NORTHAMPTON, MASS. 19Z7— Additionslh�o�z
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
I. Location Y I9CR ZEE R L-6 1< 1))Q • F40 R 15A1 C Lot No.
2. Owner's name t9 r�: �S9- DJ-0 6,J.5k Z Address Y �C R l_ 13/q DOK t)R• /::71,
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition Y U7 / S 7-0 8 226T/= Sffl: I�
5. Alteration
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 41Z, / '14� L
12. Type of roof_ s F 1) PWF
13. Siding house
14. Estimated cost- 1
X17 The undersigned certifies that the above statements are true to the best of his.
knowledge and belief.
Signature of responsible app scant
Remarks
Fee
O
kif 1 41997 oflsx tl1ttnt >�rr . i
d �ta3aaChnsclI$
DEPT Of`�' I ty YbL ENT OP BUILDDT G INSPECTIONS
212 Main Street ' Municipal Building 'a
Northampton, Mass. 01060
WORKER'S COMTENSATION INSURANCE AFFIMAVrr
(li�iLSCJperml tics)
Nvith a principal place of busmes residence at:
A1e� (phone;-)
(st Jcit};'stairj:�P)
do hereby certify, under 'L�e pasns and penalties of perjwy, thai.
O I am an employer providing the followui)g v"011ker's compensation coverage for my
employees worming on this job:
(Laurance Comp2m) (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) (Innlranc�,Company/Policy Number) (Expiration Date)
(Flame of Contractor) (Lnsurancz Company/Po!icy Number) (Expiration Date)
(Name of Contractor) azsuranct Compam,/Policy Numb--X) (F-„pirabon Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(an>ch additioml rbocd ifnoomcry to inc}isdc infocmitioo pert�.ining w 11 oodractan)
(7(� I am a sole proprietor and have no one worming for me.
( ) I am a-borne owner performing all the work myself.
NOTE:please be aware that whi]o bomcowocn wbo�IQy per o=w do,,m:._w,i_-.__, � coasv ioa'or rcpa.ir work on a dwelling of
not mode than for oo units in which the boasoowoa resides oc oa the gouods zppurtcnsr3 tbarw arc co(&,coua4 cowidcmd to be
cmployaa ts�cr tha svockcr's oempcszziim Ad(GL152 ss!(5)�application 6Y a bomcowncr f�T a Gccwc a pa-md may cvid—the
legal etatua of an aaxployeC uadertho WorlCCla CotnpomaLion Act
I underssaad tha a copy of thu rw=>a t may bo forwarded to the Dcpartmmd of Lodwtri d Aeci&a&OfGo of kv-Lra for rho
cova-age vcrifi(ztioa and that fai u=to scwre eovcrngo tmda soetion 25A of MQL 15-2 cw tmd to tbs”impa—of eriminsl Pcaaltics
consisting of a fine of up to s 1,5oo.00 tmdlor imprison ofup to one ytxr and civil pcm2tics in the form of a Stop Work 0r&r and a
find of 7100.00 a day agninA tnc
Signed this ��_day of 199 7 FccdcP r mcarsl u"only
Permit Number
M2p4 Lot#
Signature of Lib6sceRcrmittm
' 49� 1 of 'N or#}rtt»>}�tall� 1 4 1997 11TMENT OF BUILDING INSPECTIONS DEPT OF R' INSPE("'0%INSPECTOR - - ' -�'0 ain Street ' Municipal Building ?�
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
( Please Print )
DATE: V /997
JOB LOCATION:-- 9
(Map) ( Parcel) ( SSdi bdiv.isi.on)
HOMEOWNER: __fJJ_ZC IE 519 D L-.0 cc
(Name & Address )
De FLopr_=NCB
( Home Phone ) (Work Phone )
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one ( 1 )or two (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 buildinq
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. e y
HOMEOWNER SIGNATURE
BUILDING PERMIT #
d
JUL 1 4 1997 /
DEFT r T
� ay '
Al 3 �
b
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 col— to be filled in
by the Banding Z?epnrt_nt
Required
Existing Proposed By Zoning
Lot size / , J � � go C-U-0
Frontage f Q
/ / r
Setbacks O D%
- side L: /6 / R: /6 - L: (,A! R:_,, L
- rear
Building height
Bldg Square footage
%Open Space: E�
(Lot area minus bldg
&paired parking)
# pf Parking Spaces
f of Loading Docks
Fill:
_(vol-time--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
_y
DATE:_ 7 � M 9 APPLICANT's SIGNATURE
NOTE: las no of a zoning permit does not relieve an applioanre urden to oompty witl),Adl
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission. Department of Publio Works and other applioabla permit granting authorities.
FILE #
U
JLL 14 1997
DEPT zt�Z', Ia File
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
06,4/t9 L D
1. Name of Applicant:
Address: /,'/ J) R. %LOREIVU-Telephone: ,LFY ,?6 Z L
2. Owner of Property:
Address: 'S'9 Y4 Telephone: �S/3 Yl1 C
0
3. Status of Applicant: _Owner Contract Purchaser Lessee
Other(explain):
4. Job Location / �i� /� C I21-13 P 00/<, ZR�F—LO R(^NLF_
Parcel Id: Zoning Map#� Parcel#.tea _ District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTME
5. Existing Use of Structure/Property
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 11 2<1 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_,X _ 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 #
`L AAJ TC'ANTCONTACT PERSON:�,�
.RESS/PHONE:
DEPT^i
PROPERTY L CATION: - y
MAP PARCEL: ZONE
THIS SECTION FOMFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
WNIENG. FORM MILET) 0111
Fee pnid
Type of Cnnstructinn-
41YL-e-epl-
-Reinndeling
a
THE FOLLOWING 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: § I Q,tO JO, ( J(r
_PLANNING BOARD ZONING BOAAD
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 y ommission
Signature of Bull g r Da/
NOTE:Issuanoe, of is zoning permit does not relieve an applioant's burden to oompty 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 authorltles.