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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Ll 38`,, Alterations
NORTHAMPTON, MASS. 1-1 19 ED Additions
' APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location 1 e7 oZ --k;L)(`�'S �t�' � Lot No.
2. Owner's name '5- i"" 1-0 L OC C, Address 1 5•� L3 u r �� ��t Rd•
3. Builder's name b111'a -:nti Address 3`t a f�-0° R_ F U., en
Mass.Construction Supervisor's License No. (41c to 3 ci`-{8 Expiration Date
4. Addition
S. Alteration s G df'- 5tt'+ne} secIC
6. New Porch
7. Is existing building to be demolished? 420
8. Repair after the fire 4-6
9. Garage ZJ0 No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof 1"
13. Siding house
14. Estimated cost:-1�-7()()
The undersigned certifies that the above statements are true to the best of his. her
know dge and belief.
i'
Xi ature nsible appicant
Remarks
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®EPT of 17it ENT` OF BUILDING INSPECTIONS
� � aw Street Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
5g vv� L o C
(li censeel perm;tt ee}
with a principal place of business/residence at:
a (phone#)
{st7ret/ci ty/state/ziP)
do hereby certify, under the pains and penalties of pequry, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (F-cpiration 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 Company/PoEcy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/PoEcy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Poticy Number) (Expiration Date)
(Name of Contractor) Unsumace Company/Policy Number) (Expiration Date)
(attach additional shed ifnece_m y to iacbadc udorn,.pert..u melt 000iradors)
� ) I am a sole proprietor and have no one working for me.
I am a home owner performing all the work myself.
NOTE:please In aware dmi YeWlo homeowners who cnvloy pexzo=to cio maia�cj�omstvctiou or repair work on z dwelling of
not moca than dune=tt in wroth the homeowner sides or oa the grcxezbds apputteayat thawcto arc not gcnaally ooasidered to be
employers under the warker's oompezvdioa Act(GL152,s 1(5)),application try a homeow=for a ticcme or permit may evidence the
legal statue of an employer undor the Worker's Compomat Ad.
I undersU that a copy of this mtcmcnt may be fmwa ded to tho Deparwacat of IMu_,&ial Aocid=&offioo of rnsurioco for the
coverage vcnficalion sad that fad—to secure covcmgv under section 25A of MOL 152 can lead to the imposition of criminal penalties
ooastsemg of a&me of up to S 1,500.00 and/or ink of up to one year xad civil penalties is tbo form of a Stop Work order and a
fino of 5100.00 a day sga.insl ay,
Signed this I _day of l.)'J. 199-7 Fora tray ply
- Pcrmit Number
Map# Lot#
Sim of cca.^,eelPermiittc�
4'SHAMP7.
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` �J854AC�7118 tt1b
il
-m a �y PARTMBNT OF BUILDING INSPECTIONS
INSPECT ,{ Ai! 99T �) 12 Main Street Municipal Building
Northampton, Mass. 01060
Q�OF BUILDS °..;;
NQRT'n`. : .. .
HOMEOWNER LICENSE EXEMPTION
DATE: I � -"c1
(Please Print)
JOB LOCATION:
(Map) ( Parcel) ( Subdivision)
HOMEOWNER:
(Name & Address)
(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.
i
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 # y
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10. Do any signs exist on the property? YES NO 7�
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 cclLu= to be fillad in
by the Building Department
Required I
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paged parking}
# of -Parking Spaces
# of Loading Docks
Fill:
-(volume-& location)
13 . Certification: I hereby certify that the informati o a ' ed 4n
is true and accurate to the best of my know edgy on
DATE: APPLICANT's SIGNATURE Lr22v/tA-_A
NOTE: lssuanoe of at zoning permit does not relieve an applicant's burid to comply With all
zoning requirements and obtain all required permits from the Board o Health, Conservation
Commissian, Department of Public Works and other applicable permit granting authorities.
FILE #
NOV 1 8 10,917 File
ZONING PERMIT APPLICATION (§I0 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: I a V i d ` Y) ry-th G"'t
Address: S9 U V`='V LIB K bP?, FCo^e/ic6. Telephone: G_?5G ` ct 3e,A
2. Owner of Property: 6<<rn �-"� 6c c�
Address: (I S ;� 3c;r+s 9 ZU2c-cx CTelephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# Parcel# / ` �J District(s):
(TO BE FILLED IN BY THE BUIL DING DEPARTMENT)
S, Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupabon: (Use additional sheets if necessary):
t�CY�� tSJE'� t:x rS,h nc� DCL K
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/Vadance/Finding ever been issued for/on the site?
NO DON'T KNO:^: 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)
fD l
FILE # �� . J
V 1 8 1997 _ Al
APPLICANT/CONTACT PERSON:-
ADDRESS/PHONE:
PROPERTY LOCATION: 115 '21 �C1
MAP PARCEL: ZONE_ '
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM ETILED.011T
Fee Pnid
Rnilding Permit Filled out Le�_
Fee Pnid
Remodeling Interior
Addifinn to Existing
Accessary Striiefiir;
1/
THE LLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION-
looll 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:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval-Bd of Health Well Water Potability-Bd Health
Permit from Conservatio ommissio
Ld
Signature o ui g r Date
NOTE:issuanoa of a zoning permit does not relieve an applloant'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 authorltles.
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