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Zoning_a I
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. S8�° "503 Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
/ l Garage
1. Location 4e A STi,4 Ci 1rCA Lot No. �
2. Owner's name S7Y p hea "7 Address G //0 T/ib C-,*-�'C
3. Builder's name T ZA i Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition -
5. Alteration
6. New Porch
7. Is existing building to be demolished?- 'Alo
8. Repair after the fire N4
9. Garage No No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost:- °�I g SO• ao
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible appicant
Remarks
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Qr4f� of 'Nortl1ally foil
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECT R 212 Main Street ' Municipal Building '�+M 5 ;•
T Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
c�
DATE: (Please Print)
3 OZ� I f
JOB LOCATION: oZ / ot- 3 Ss-
ff (M ) ( Parcel ) ( Subdivision)
HOMEOWNER: S ct•n fO71
ame & Address )
/ sf i� �,�tr-e�t� le3ronc S44 -5 ?03 S A
( 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 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 responsibi-lity
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 #
a �'.--• �lasaxransrtta
m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
with a principal place of buswess/residence at:
Florence 141q (pbone#) g1.
(street/cih' �P)
do hereby certify, under the pains and penalties of pegilly, that:
( ) I am an employer providing the following workeijs 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 worker's compensation policies:
ore 5 k• Ck )IM
(Name of Contracto (Insurance;Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/PoLicy Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy/PoLicy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/PoLicy Number) (Expiration Date)
(anach additiomt*bed if neo=vLry to inchidc mforz i oa pertaining to all ooatxnci )
VI am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be awuc that while homeownaa who crnploy person to do caA•icaza cr,coamuctioa or rrpair wont on a d%yetling of
woe nx)m than throe units is which the houv5owncc rmdcs or oa the grounds appurtenarrt ibw to arc not gaoordly ooasidacd to be
employ=undo the workees pompcw4ca Ad(GL152,n 1(5)),application by a homeowner for a Gernso cc prrmii may evidcaee the
legs!ctalu of an employer under the Workeeg Compeoution Act
I undetsiaad thst a copy of this ciat emsai may be forwnvdod to tba Deportmco2 of lndushial At &O&Offioo of Imvrsnoe for the
coverage vcrificatioe and that failure to scrure covttagn undo soctioa 23 A of MOL 152 can lead to the imposition of criminal pcnal6es
comisting of a fine of up to S1,500.00 and/or impriumncnt of up to oa year and civil pemlties in the form of a Stop Work ocdcr and a
fins o(3100.00 a day against ma
For use Daly
Permit Number— .
Lot#
;;: Sig aahTre of Liccnsee/Per ittec Mite
_
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10. Do any signs exist on the property? YES NO V
1F YES, describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES _ NO y
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
Thia cola= to be filled in
by the Building Department
I Required I
Existing Proposed By Zoning
Lot size
Frontage / Q o2 `
Setbacks
- side L: l R: 63 L: /6 SR: 6_3 1 5�
- rear S 3
Building height
7 �7
Bldg Square footage tv � /,S1
%Open Space:
(Lot area minus bldg g 7 o/O
0
&pa.Ved parkingf
# pf -Parking Spaces
# of Loading Docks
Fill:
-(volume--& location)
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
DATE: 3 a t� f`� APPLICANT's SIGNATURE
NOTE: Issuance of a zoning permit does not relieve an appl oant's burden to oomph witfryali
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission. Department of Publio Works and other applioable permit granting authorities.
FILE # Cj
S
Li NYAR 3 I 998 ;�
File No.
A
o { +"rsPECTI(INNING PERMIT APPLICATION (§10 . 2)
L{ rna .fir �
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: S44ehen D ' t 14-i7"_
Address: / q,8 C;-rC, >° Telephone: �$ � S_7 6 3
2. Owner of Property: S7'Cp ^^7 ;7
r `A
Address:t�iti1 /C fYC le r/'r^C*VCt0 Telephone:
3. Status of Applicant: ✓ Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: --! - �' �"
Parcel Id: Zoning Map# L�;;22 Parcel# �3, J District(s)�L
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Desc ' ton, of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
! e c k G a Z-r e9 sp gt
7. Attached Plans: v 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.
S. Has a Special PermitNariance/Finding ever been issued for/on the site?
NO DON'T KNOW v 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)
1.
_ 1�x�.� - FILE # 9 6 1 3 3
`
%&& A/CO4ACT PERSON:
PROPERTY LOCATION: A"JTe
MAP PARCEL: 13= ZONE 16M Cc
THIS SECTION FOR�OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
MWMG-FORM ITHLED OUT
Fi-t- Paid
13iiildi nut
�.
T OLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION-
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
I/
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 ommission
Signature of Building I.4e for Da e
NOTE:hmuanoe of es zoning permit does not relieve an applioant's burden to oomply with all
_ zoning requirements and obtain ail required permits from the Board of Healtho Conservation
Commission, Department of Public), Works and other applioable permit granting authoritles.
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