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32C-268 (8) _ > > Z LCD c:. ViL 3 O rn z > � O 2 p -1 +O I A Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. SSS—65-2 C. Alterations ✓ NORTHAMPTON, MASS. 6 - 3 19-n Additions — APPLICATION a APPLICATION FOR PERMIT TO ALTER Repair Garage 1. Location_ +30�-(r�LL1j}w/S ST. >�ic91144r�Pro�y mA Lot No. 2. Owner's name �l r� A-2 l91(z-rc,,3 Address , e ,L/�'� Aj p� n* 3. Builder's name_ ���y� 177VA C5Z � Address q� rlyd� �e� A- Sff. - 4 C Mass.Construction Supervisor's License No.0 ,/.C. Expiration Date 3 -11- 98 4. Addition 5. Alteration t�i 1 /r1Bu eeW1.0 -Ae AQ911 Go✓erl)4-11l8 .1Nsu� �'Td- �(. y�`�'7-f1o�Y. ev�1 a G► �.►, 6. New Porch 7. Is existing building to be demolished? 8. Repair after the fire 9. Garage No.of cars J Size S-3 !(2-0 10. Method of heating 11. Distance to lot lines 12. Type of roof e�tAL 13. Siding house 14. Estimated cost:- The undersigned certifies that the above statements are true to the best of his, her knowledge and belief. ALWiure of responsible appii ant Remarks 9)(4k BOOR TOLS7� O•-1 C0A),- e-TE Ly1711 ON- PJ-AT'E- O4S1tAMp�ODE"�•� Ti.� 5 1997 OF SUIl.VJIG INSPECTIOR'EPARTMENT OF BUILDWG INSPECTIONS Main Street • Municipal Building Northampton, Mass. 01060 y WORKER'S COMPENSATION INSURANCE AFFIDAVIT L Ott^__3 ctJ3Sc» (licensee/permiuee} with a principal place of business/residence at: 30 kA I, Srt. !) )170-01 Ml (phone#) S-8cJ-341"f (st =UCity! rip) do hereby certify, under the pains and penalties of pegury, 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; eneral contractor or homeowner(circle one) and have hired the c elow who have the following workers compensation policies: (Name of Contractor) (insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Compaay/Poky Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (atlanh addition2l sheet ifnoocnary to include information pataiuing to all aatrnctom) ( ) I am a sole proprietor and have no one working for me. (vYI am a home owner performing all the work myself. NOTE:please be aware that while homcow=3 who employ paso=to do B,0,= constvctloa or rcparr work on a dwelling of aot more than throo units is which the bomeowner sides or on the grounds appurknacd thacto ace not gerxrally 0oasi&=1 to be employers under tba wockcr's compeasation Art(GL152,ss 1(5)),application by a homcown<r for a liccnsc tic permit may cvidcaoc the legal ti.ahsa*fan employer under the Worker's Compemation Act I understand that a copy of this rlatemcat may be forven ded to the Dgmrtx art of i.&L'ri al Amides ofoe of Iasuranoo for the coverage verification and that failure to t:ecure cov,:T g under sceiioa 25 A of MOL 152 can lead to tbo imposition of aimi W peailties oomisting of a fine of up to$1,500.00 and/or imprisonmcat of up to one year and civil pcnattia in the form Of"Stop Work Order and a fins of 5100.00 a day against me Signed y of c!a 199 7 For dq trncntal usa only Permit Number ZI Map# Lot# Si 0 1 ttee �•'�o o* � . � .:�l5�U t5 � . 4 Z� �� IIz� Nlll �LtIY WIZI �I . JUN 51997 ,} .fUesancfluaetla DEPAhTMENT OF BUILDING INSPECTIONS DEPT Of SUIi_C3!"•!G IMSPE�Tot 212 Main Street Municipal Building INSPECTOR Northampton, Mass. 01060 HOMEOWNER LICENSE EXEMPTION (Please Print) DATE: - 4-q 7 JOB LOCATION: 30 1 n e (Map) (Parcel) (Subdivision) HOMEOWNER:- H&z 61 1,-;�So7J ,• , (Name & `'Address ) O/v&o (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 Laws, and State of Massachusetts General Laws Annotated. r. HOMEOWNER SIGNATURE BUILDING PERMIT _. .. .. . . . ... .. ..._. R. IN 51997 . ,) d no F Rt zo fl , t T ' d i « N D 1 , 1, i N X i s ' 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. TM, col— to be filled in by the Bni7.ding Department I Required I Existing Proposed By Zoning Lot size Frontage Setbacks - side L: R: L: R: - rear Building height Bldg Square footage %Open Space: (Lotarea minus bldg &paved parking) # pf -Parking Spaces ht of Loading Docks Fill: 4vol-ume--& location) 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. .1 DATE: �, ,3- 97 APPLICANT's SIGNATURE NOTE: Issuanoe of a zoning permit does not relieve an p io s burden to oomply wltf?1 ,+pU zoning requirements and obtain all required permits f m he oard of Health. Coinservation Commission. Department of Publio Works and other app oable permit granting authorities. FILE # o �r rr,{ .All 5W DEPT Of 8tip-7 NZZ File No. ZONING PERMIT APPLICATION (§10 . 2 PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: !//tl/6//�t/ Tl. �ynrfo� 11 f�. Nrr�'E" KJ�T/anLS Address: V, y /J'/t t (Ct 1'1A. � Telephone: �S'8S=8S2 6 2. Owner of Property: 6-01 Cwt Q.Ctrj Address: © �LJs�++-1 .�?. Telephone: 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): rit17/tAfJ—V;Z 4. Job Location: 30 60%1u—on,.t �. �c)RTN,�N•Pi�,_ ///r9 Parcel Id:- •-Zeg Map# �7 Parcel# o26 _ District(s): (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property 6ya6E- EX�s-r-j 7c) 6. Description of Propos d Use/Work/Project/Occupation: (Use additional sheets if necessary): ,97vAY PI&Yficap-% 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 PermitAlariance/Finding ever been issued for/on the site? NO DON'T KNOW—z— 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_,,ff' 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) J l y FILE I r E JA 5 07 APPLIC T/ ONTACT PERSON: OEPt t1T SUtI NQRT iH NE: H_�,� ,.....,.� `� PROPERTY LOCATION: MAP PARCEL: ZONE THIS SECTION FOR-OFFICIAL USE ONLY: PER UT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Ft-f, Paid / $ -�. THE�LLOWING 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:§ w1ZONING 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 Conserva ' Co n ..�—Z Signature of Building Wector Date NOTE:lasuanoe of at zoning permit does not relieve an applloant's burden to oompty with all zoning requirements and obtain ail required permits from the Board of Health, Conservation Commission, Department of Publio Works and other applioable permit granting authorities. 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