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29-351 (7) DRTGAGE LOAN INSPECTION x t 1� -ter To �f15E"M�NTS -7-0 ?` Y ce S t �e I A U S ! Ai hereby report that the premises shown on this plan is not located within a Flood f Area as shown on Department of H.U.D. Federal Insurance Administration Maps, Community 'Nu er 250167-0001A Identificati ;te, ApAil 3 8 By: , _SPRINGFIELD INSTITUTION. FOR SA v__ OWNER, RONALD J. S LOUISE A. BUSHEY .FIRST AMERICAN TITLE INS. CO - ONLY 'j ON' 40 AUSTIN CIRCLE +hp hest of my knowledge, informa- NORTHAMPTON, MASS. that t Al MER HUNTLEY,JR.81 ASSOCIATES, INC. -• "craS .PLANNERS DRTGAGE LOAN INSPECTION ,r -,=7- 7'0 `Ta 0�! - i i r. i N °J f� ` M 110 -- �-a L i W��-. 9,ANtX- N. p u 1 , /m ac-L -2., hereby report that the premises shown on this plan is not located within a Flood i Area as shown. on Department of H.U.D. Federal Insurance Administration Maps, Community Nu er 250167-000IA Identificati to A it 3 8 Bys , SPRINGFIELD INSTITUTION FOR SAVINGS OWNER "'r'"""�r'— RONALD J. & LOUISE A. BUSHEY FIRST AMERICAN TITLE INS. CO - ONLY LOCATION' 40 AUSTIN CIRCLE the best of my knowledge, informa- NORTHAMPTON, MASS. that t Al MER HUNTLEY.JR.a ASSOCIATESs INC. 1&,A1W1!FRS.PLANNERS � * 'v ,> o j v a Z ^' m Zoning !iscellaneous Additions,Repairs,Alterations,etc. Tel.No Alterations NORTHAMPTON, MASS. 9 Additions APPLICa ATION FOR PERMIT TO ALTER Repair Garage Location Lot No. Owner's name 7tJ�\b � � _Address L'b Pty�� G\ct• Builder's name �NPr��":� �Vs��� _Address q-c_- Mass.Construction Supervisor's License No. Expiration Date Addition L140DD CSM Alteration New Porch Is existing building to be demolished? Repair after the fire Garage _No. of cars Size Method of heating - Distance to lot lines Type of roof Siding house Estimated cost:- 6 W o t ' The undersigned ifies that the above Statements are true to the best of his, her knowledge an be Sign we of responsibte c nt marks i MORTGAGE L INSPECTION SciBrcrcr To S TS '7p f i i 1 w� � 1\ i 1 � M A^ n f Fil Sao •� s��� � r � , i � , � f l —__ — ----.__ .. I i i I i I � � � � � i ( � f I i --- ! � -- ,----�-�--r � ; �� ii I, ' ;� f �--�� � � ' ' � ; ; � ----a--- i � � ' ' C� i � � i r � I i � � `' i � �, �. � � � i � '\ i 's i i -- - ! i f i I � i I ----�— i i _ I i I i j i i � I II I ! � i � � i I � � ! I � '' i i I li i � i I i __ � l i � � I I ` � I ' Iff ' � j � � �. I � � -- )----� , � j � � / ---� - I I � __ , , W N� �o R^, G, � v i t - I � f J J` C Z I i r i j I)I I I , �I i I I i 1 t i I i i � I I � i 1�I1` O \ cF VN Y 7 , A °m i G i ' ,I Vv • ! �lHA1d pT �° 0 Cris of r �+cisrtrF(ttsttts m DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT L &6h� (license&permittee) with a principal place of business/residence at: tJ Q1(Z t JCA— `iN N (phone#) S-g �'IK (street/ci t:y/stalr/u p) 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 working 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 workers compensation policies: (Name of Contractor) (Insurance Conrpany/Policy Numbcr) (Expiration Date) (Name of Contractor) (Insurance Conipany/Policy Number) (Expiration Date) (Name of Contractor) (Insuran(--Corapany/PoLicy Numtxr) (Expiration Dale) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional shit if ncorssuy to include iafocmatioo pextaiuvrg to au ooaractors) ( ) I am 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 homeowners who employ pcxsoas to do mai.,renan c c=itucuou or repair work on a dwelling of not more than three units in which the homeowner r=des or on the grounds appurtecaat thereto are not g—ally co-Wered to be employers under the worker's compensation Act(GL152,ss 1(5)),application by a homeowner for a license or permit may evidence the legal etatua of an employer under tin Worker's Compomratioa Act I understand that a copy of this statement may bo forwarded to the Depwuncot of Indwtri al Accidents'O$Soo of Iazwxace for the coverage verification and that failure to secure coverage under sw1on 25A of MOIL 152 can lead to the imposition,of aimhw penalties comisiing of a fine of up to 51,500.00 and/or impris of up to one year and civil penalties in the form of a Stop Work Order and a film of 5100.00 a day against tne. St ed_ s N*� da of t( `= 199 7 For dcpartrsr use only C Permit Number Map# Lot# Signature of Li 'flee =o��nnMpTOy Crz#fir oaf ���tl��nt}��o�T� 1 B Alas 0AC11 Ili tIts �. DEPARTMENT OF BUILDING INSPECTIONS NSPECTOR 212 Main Street ' Municipal Building Northampton, Mass. 01060 HOMEOWNER LICENSE EXEMPTION IU (Please Print) DATE• �. JOB LOCATION• (Map) (Parcel) ( Sedivision) HOMEOWNER: ���173 >; � +3 C`1U��tr� �.�R l<��t�t.�G'z. "N_ (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 fore hire who does not possess a ` license, provided that the owner acts as supervisor. CMR780 Section 109. 1 . 1 DEFINITION OF HOMEOWNER: Perscn( 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 BUILDING PERMIT # • 10. Do any signs exist on the property? YES NO Z � IF YES, describe size,type and location: Are there any proposed changes to or additions of signs intended for the property?YES NO�z IF YES, describe size,type and location: II. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. This cc7=mn to be filSed in by the Bnil.ding Department Required Existing Proposed By Zoning Lot size � � ,� �� � � � U Frontage Setbacks 60 ' cv - side L: R: L: R: 3o-z J - rear 3c) Building height Bldg Square footage %Open Space: ao `fo (Lot area minus bldg ' &payed parking) ,# ..pf 'Parking spaces ,# of Loading Docks Fill: =(vol-ume--& location) 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. DA-'I'E: - APPLICANT's SIGNATURE NOTE: issunnoe of a zoning permit dons not relieve an appiioanYs burden to comply viritt7,pll zoning requirements and obtain all required permits from the Board of Health. Conservation Commission. Department of Publio Works and other appiioable permit granting authorities... ,,;, FILE if • • File No._ ZONING PERMIT APPLICATION (§20 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: Address: —Telephone: !Scs� 2. Owner of Property: Nrr�ytJSl�i�� Address: QA 0, Telephone: S �';` 3. Status of Applicant: ;,_Owner Contract Purchaser Lessee Other (explain): / 4. Job Location: Parcel Id: Zoning Map# Parcel# �_ District(s): (TO BE FILLED IN BY THE BUILDING DEPART�IENTI 5. Existing Use of Structure/Property_ 6. Description of Proposed Use/WorkJProject/Occupation: (Use additional sheets if necessary): cl L A d-d 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. 3. Has a Special PermitNariance/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 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) 4 0 FILE # • APPLICANT/CONTACT PERSON: ADDRESS/PHONE: PROPERTY LOCATION: MAP ? PARCEL: , % ZONE,_-1_1 THIS SECTION FOR-OFFICIAL USE ONLY: PERMUT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FTT LED OUT ✓ Fee Pnid Rnil_riing Permit Filler! pert Fee Pairs Or llQs -8Z&G` C Remnrlelinn Tnterinr Arlrlitinn to F,Yicting Arrecenry Strurture RnildingPlnnc Tnrhirlerl- THE FOLLOWING ACTION HAS BEEN TAKEN ON TMS AP ICATIW Approved as presented based on information presented Denied as presented: XSpecial Permit and/or Site Plan Required under: _X_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/ZON NG 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 mmis •o Signature of Building Lisp or ate NOTE:Issuanoe of a zoning permit does not relieve an applioanYs burden to oompty with all zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Department of Pubiio Works and other npplioable permit granting authorltles.