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35-228 (2) a 1 70 'L3 D m a r g A Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. s��` `f3 Alterations i NORTHAMPTON, MASS. ,Qr/�-�L- l 19 Additions APPLICa ATION FOR PERMIT TO ALTER Repair ` Garage 1. Location Z hA643LW g-k AlQtLTH /`f t4A ©166 v Lot No. ,/ 2. Owner's name � 1—(-./j4$,Ad Y- L(JNir&i rer �,r4f9rT Address l !?9 �-�✓/� 2 E.,� /9lF,ej% -7,gd kf4 3. Builder's name r)tiJN rr-iz-- Address Mass.Construction Supervisor's License No. Expiration Date 4. Addition ��^• ��" 5. Alteration /-,W,.SA( 7kS U0- 1 tGn2� 6. New Porch 7. Is existing building to be demolished? 8. Repair after the fire 9. Garage Of No.of cars Size 10. Method of heating 0/ if"�CJE 6(JA—MIL c,t 11. Distance to lot lines 12. Type of roof 13. Siding house 14. Estimated cost: i The undersigned certifies that the a e stat ments are we to the best of his, her knowle a dbell �-- g° c 'nature of responsible app,icant Remarks ot, P£P— I -4YJ • YL� 57r1L GJ,4t c, c /A/,S4A-A1 i,/t Art 4t(- 4u,?r,E�'a/— A^kb G a- 2717 G/ "a 01 t � rn Pz At \ ' ` � APR \ , �� . \ '` ' - ------- �� - -----' ' | - / . �� -- --------- `� Lhi l' if Grit of ��az#l�tt�it�r�>riY APR r . 6 1995 _,AEPARTMENT OF BUILDING INSPECTIONS INSPEC R,.-pl, 212 Main Street ' Municipal Building Northampton, Mass. 01060 " HOMEOWNER LICENSE EXEMPTION 41,��� (Please Print) DATE: JOB LOCATION: (Map) (Parcel) ( Subdivision) HOMEOWNER: A,c.i,IM ,t R17it454 / I"Her7_ ,CAgV,1_4WJr/Z /_J (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 . The undersigned "homeowner" certifies and assumes responsibility ' for compliance with the State Building Code, City of Northampton Ordinances , State and Local Zoning Law and State of Massachusetts General Laws Annotated. HOMEOWNER SIGNATURE ,! BUILDING PERMIT # �o4cTO� s Cr cifnxl� ntarr a�pppp 61998 � _ 9 !Ynasaacansrtta m QE IARTMENT OF BUILDITNG INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORKER'S COMTENSATTON INSURANCE AFFIDAVIT (licensuJpermittee) with a principal place of business/residence at: LqhYL4_,,z ceg a l!/d1'-rhL m .��N I A (phone#) (st1r_t/city/stalflaP) do hereby certify, under the pains and penalties of penury, that: ( ) I am an employer providing the follovvi-rig worker's compensation coverage for my employees worming on this job: (lnsura-nee 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 Company/PoLicy Number) (Expiration Date) (Name of Contractor) (Insurance, Company/Poky Number) (Expiration Date) � 4 (Name of Contractor) (Insurance Company/PoLicy Number) (Expiration Date) (Name of Contactor) (Insurance Company/Policy Number) (E)piration Date) (attarb ukHomd sheet ifnooc Ary to indudc infocmirion patbiaing to.11 ooatrvc ) ( ) I am a sole proprietor and have no one working for me. (cram a home owner performing all the work myself. NOTE pleaae be aware shad while homernwcrs who employ pasoas to do maiatcnsac�coozwcdoaor repair work on a dwelling of not rnom thaw thrco uatu is which the hortroowacr resides or oa the groao<u sppuste ma lh=to arc not gcoctally coandcrrd to be employrcra tinder the worker's comps ns4oa Act(GL,152,s3 1(5)).application by a homeowner for a liorase ac permit may evidence tho legal stahra of as employee under the Wockor's Compensation Act I uzAcestand dust a oopy of(hit ctdcmcat may be focvrarded to tkia Dopwtmm2 of Lo&eftial Aecadoa&Ofoo of Iaxrranoe for the covctxge vcrificadioo and that failure to secure coverage under soctioa 23A of MOL 152 cart lead to the'imposition of criminal penalties ooaiist mg cf a En¢of up to 51,100.00 and/or imp¢iso=nent of tip to one year and civil pcmttia in the form of a Stop Wor14 Order and a Frn of 5100.00 a day apiast Me ✓1 For dcputmwW We cdy / Permit Plumber 6 I l7# I of# Y. Sigi abire.of LiainseeRermitnx 7 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 DOE TO LACK OF INFORMATION. This columm to be filled in by the Building Ikpartment (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 &paved parking) # of Parking S_ ces # of Loading Docks Fill: 4 volume -& location) 13 . Certification: I hereby certify that the information co ained herein is truAadd accurate to the best of my knowledge. DATE: APPLICANT'S SI"GNATURE NOTE: lasuanoe of a zoning permit does not relieve pplioant's b rden to oompty v✓ittr_all zoning requirements and obtain all required permits from the Boa of Health. Conservt�tion Commission. Department of Pubilo Works and other applioable permit granting authorities. FILE # APR wa File No.__1.�_- -)EPT� rt „ :'? st: ➢cifis ul�r.J ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: 141611,_LlAli * 1z1'r 'V6 l Address: v'Z- Z ;-xx.Lii" t�c+$r1.QA Telephone: 5 -7 ,V? 2. Owner of Property: Address: Telephone: 3. Status of Applicant: #___Owner Contract Purchaser Lessee Other(explain): 4. Job Location: �Z Ki9,OG,�"'alaj " L'z-) t / Parcel Id: Zoning Map# _ Parcel# District(s): (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property— Z' 6. Description of Proposed Use/Work/Project/Occupation' (Use ad itional 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 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 i./N'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) l� u U LS i 7 �] .. FILE # 9 U Ci j APR 6 M8 ' APPLICANT/ ONTACT PERSON: ERT is R4,� --- ' �T. PROPERTY LOCATION: �e1 MAP 19Y PARCEL: ZONE THIS SECTION FOR-OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE 'Riii1ding Permit Filled mit Fee Paid 9 11�1._ Z/v I axe TBE,Y,OLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION: Approved as presentedfbased on information presented Denied as presented: Special Permit andlor 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 Conservation Commission g G� Sign e r �:.� a-x ,. Date NOTE:Issuance 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, Department of Public Works and other applicable permit granting authorities. a C1 b awe co CD � a a• CAD O O 'm.s+l, a � � 05ExD w n �D p� y� ►�, (D dl .+ N W c 0 N O C! N W 00 W rA � r L= En CD c � cD c. 0 rj), Fj' Y CD rp,Q. �-•� cD b b (D w In `J gin' c. 0 O cn N rt (D �- 0 d CD �" p.� 5 N Q• � " rt In r~t CC �D rl t:� 5� cyoOO � � n rt O CA CrQ � O O c 0 5 td 5 5 d v CD O 0 0 � a � (� o arc o 0 0 5 �- 5 5' S o °q o y M � c) 9 � �, a p C7. G W N �, 0 5 trc 5 °° °c n C� Cn ►x7 (IQ 00 tv ID o a V1 5 0 H tai Ln z o co v r m � tO a DWR to NOT A a. a ➢ �a4 � Y :� ,tm{ f S t A' 4'. 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