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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel��No. QQLV/ Alterations
a rNORTHAMPTON, MASS. 00 19vW Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location K kl ��^^MO 9Z' Lot No. ii,,,,
2. Owner's name d t -M Address &A-41 _ ao L--tYlouy,
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition n,1
5. Alteration �1"�` r-,k-boue `
6. New Porch
7. Is existing building to be demolished? no
8. Repair after the fire Y) )
9. Garage_ L} No.of cars (-4 Size
10. Method of heating
11. Distance to lot lines—
12. 1
12. Type of roof A21f-1
13. Siding house N r�
14. Estimated cost- I I
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible app,lcanl
Remarks
t�M P�
a Crib of 'Nart4alliptalt L
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFMAVIT
. (licenseelpermitzee}
with a principal place of business/residence at:
(sticet/ci ty�st.atriz�p)
do hereby certify, under the pains anal penalties of perjury, that:
O I am an employer providing the folloti ui lg workerJs compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Daze)
( ) 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 Comparry/Policy Number) (Expiration Date)
(Name of Contractor) (Instrarice CompauyiPolicy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/PoLcy Number) (Expiration Date)
(Name of Contractor) (Iwulaace Company/Policy Number) (Expiration Date)
(attach additional shod ifmx a to in�iaform.6oa pertaining to all ocatracton)
( ) I and a sole proprietor and have no one working for me.
(-I am a home owner Performing all the work myself.
NOTE:please be aware that while homcowocrs who employ pazom to do ;••l••m•,,c cuastr on or rzpair work on a dwelling of
not more than three units in which the ho=owncr resides or on tSe gFOUnd3 appcutenani thereto an not generally coa kk-d to be
employers under the wmkcex.ration Act application by a homeowncr for a license a permit tray evidence the
legal&W- of an omployer under the W orkeet Compensation Act
I understand that a copy of thin ztatcmcat may be forwarded to tbo Dopdiu c of T,dr, ri al Accidca&Off o0 Of Iasunnce for the
--mge verification and that failure to scathe covaamp under section 25A of MGL 152 can kid to tho imposition of criminal pcnaltica
oomi song of a fine of up to S1,500.00 wuVor knpriuo of up to one year and civil pcnattia in the form of a Stop Work order and a
film of S 100.00 1 day apinst me.
For dcpartmrstnl Use oatY
b na Permit Ntimber-
Map# Lot#
i of Liocnse&Permittce
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22 �
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060 '
HOMEOWNER LICENSE EXEMPTION
� j (Please Print)
DATE: r7 9
JOB LOCATION:
(M p ,( arce ) ( Su)6division)
HOMEOWNER
(Name & Address)
Y 00
Home Phone) (Work Phone)
The current exemption for "homdowners" 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 Laws, and State of Massachusetts
General Laws Annotated.
HOMEOWNER SIGNATURE C( ""-Nit4baij
BUILDING PERMIT #
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APB?
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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 C01== to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size 261 lb ! a o I l o '4 J UU-U
Frontage
Setbacks - frnnt r7q, Z r7 t4.-R 01 /
- side L:61 q' R: k L: (R:
- rear
Building height
Bldg Square footage /bq �0 1
%Open Space:
(Lot area minus bldg
' bpa.ved parkiig) ) (J
# of Parking Spaces G;�1 �n�7 `�� �
#
'of Loading Docks &A-K-.k,
Fill:
-(volume -& location) N/A 'v
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
DATE: - C, APPLICANT's SIGNATURE f
NOTE: lasu noe of a zoning permit does not relieve an ap ioan4Vs burden to comply wit oiiol
zoning requirements and obtain all required permits from the Board of Health. Conservtation
Commission, Department of Publio Works and other mpplionble permit granting authorities.
FILE #
f
APP 2 21998
Fi 1 e No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: Anveo R, -Fl6 baticH
Address: q a:l .lL FjOYV?& Telephone:
M 0f 609-
2, Owner o 6(, 1)
Address: Telephone:
3. Status of Applicant: L_�Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: 433
Parcel Id: Zoning Map#--s!-�-- Parcel# 2/� District(s): -
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
proo Q- �' (,�-�c r/TXX/'
0�
"0 ce
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 PermitNadance/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 ®P—L51,57 Page and/or Document# q/7 66 1.5,5g
5g
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)
F r 1
.!A FILE I (�J U �) ,i 3 ) {4q /
APR
APPLICANT/CONTACT PERSON: J ��� - `3"��724,
' ADDRESS/PHONE:
PROPERTY LOCATION: 6ta,x
MAP PARCEL: ZONE
.22 THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
710NING FOR M LED MIT
Fet-paid
Bifflding Permit Filled nut
Fee Paid Afl -
--
Q
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: §
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
{�- n' 6ptic Approval-Bd of Health Well Water Potability-Bd Health
S
Permit from Conserva ' Commission
Signature of Buildin ector Date
NOTE:Issuance of a zoning permit does not relieve an applioant'a burden to comply with all
_ zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Departmant of Publio Works and other applioabla permit granting authoritles.
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