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32C-268 (9)
r O � n• 3 c oL40) Z m CIQ c R z S ft Ln Z ... -� a I A Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. �� `F _ 39-1 Alterations 40 NORTHAMPTON, MASS. A"t,� 6- ZZ q Additions APPLICATION FOR PERMIT TO ALTER Repair Garage 1. Location 31-C> L 1 +VyA $ S r f Lot No. 2. Owners name V >f+ G ! °/� Address 3,C1 LU< ( <t fi-I�� -�•T t 3. Builder's name S'Arm 7u- Address � /V M Mass.Construction Supervisor's License No. Expiration Date 4. Addition 5. Alteration I !V S -rA LLB- W A S TG \J F-7 6. New Porch 7. Is existing building to be demolished? 8. Repair after the fire 9. Garage No.of cars Size 10. Method of heating 11. Distance to lot lines 12. Type of roof 13. Siding house 14. Estimated cost- The undersigned certifies that the above statements are we to the best of his, her knowledge and belie A. Qd-f4m_(, A Signal a of responsible app,icant Remarks 0ttt^1fP� `c1 \ fip c' So 0 ollb_ 2 5 r.9 1 GHL i°f wart1lanlpfon . B t . was:arytt:<<lQ co `DEPARTMENT OF BUILDWG INSPECTIONS n 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORrCER'S COMPENSATION INSURANCE 1 r AVTT >0 (Li�nsa/permi ltcc) with a principal place of bttsnesslresidence at: e7 LAj 1 L L l A-/'A S (phone, ) (Stir-.t/ci h'/st2_ic/zi p) do hereby certify, under die pains and penalties of perjury, thai: O 7 am an employer providing the following v.,0r-�ers compensation cove:age for My employees word.-ng on this job: (Lnsurance Compzay) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, general contractor or (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Concmceor) QInsuraac;,Company/Pobicy Number) (Fxpim6on Date) (Name of COOLMC10r) (Lusurancr CompanyiTolicy Numer) (Expiration Date) (Name of Coammor) (Lsuranc-- aupa_�,/Pohcy Num_bzr) (F--piraaon Date) (Name of Contractor) (Loswanc-- CompaDy/Policy Number) (Expiration Date) ( additioozl ibc._i to cxk>dc inforin.�oo pert_imng to�u oedr-..won) X am a sole proprietor and have no one worL-ing for me. am a-home owner performing all the work myself. NOTE_Please be asr,rc thct wbilo bomcowncra wbo aaplay pains to do mxi: ate,caaxructioo'or rcpxir work m■d-viLing or aot more tb_n tbsco twits i a which the bomoo,o rocks or co Lb,-cmu rpptutcaint tbado tic oo(gcaa ably comidacd to be employ—under tbo worker`s o ciim Ad(G Li 52,=l(5)�applintion by a homeowner rer a liccwc tic permit may cvidcnoc the kgsl rtanrt of as cmployx uod<rtho Wort S Coospooaitioo Ad' I uoj ' ad d"i A oopy ofthis edtcmmi m.y bo foe v nrded to tho D"em orin&u d Accidcat:f Ofso of lawranoa for the covcn6e vaifiesiioa and that failwt to t=m covca tinder soctioa 25A of MoL 112 c=to d to the iaVositiou of nrimiatl Pcadties ooqu3t tg of x.-fine bf up to s 1,5oo.00,mdra impr600�of up to occ yc tr and civil pcmitic in the form of n Slop W otk Otda and a fiao of 5100.00&&y agpinst.me. Signed this 717— y of /�y iJ' 1997 Fades t�.�oa►y Permit Number Map;Y Lot if Si hire of Li ctmitdrx �K t1Mf PT 9 Gf ifs of No:di aillp toil yn asbarlillof Ills DEPARTMENT OF BUILDING INSPECTIONS = INSPECTOR 212 Main Street ' Municipal Building Northampton, Mass. 01060 N HOMEOWNER LICENSE EXEMPTION ( Please Print) DATE: ZZ _ JOB LOCATION: (Map) ( Parcel ) ( Subdivision) HOMEOWNER: __,7O 4N (, i "0 N �44 ��° �(i G VHS S�, (Name & Address ) 3 ( Home Phone ) (Work Phone ) The current exemption for "homeowners" was extended to include Owner-occupied Dwellings of one ( 1 )or t�,,o (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 . 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 Annotate HOMEOWNER SIGNATURE BUILDING PERMIT # 10. Do any signs exist on the property? YES NO V 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 cola= to be filled in by the suildiay Department Required Existing Proposed By Zoning Lot size Frontage Setbacks - side L• R: L: R: - rear Building height Bldg Square footage %Open Space: (Lot area minus bldg ' &paved parking) _Pf Parking spaces #` fof Loading Docks Fill: 4vol-ume--& location) 13 . Certification: I hereby certify that the information cRntained herein is true and accurate to the best of my knowledge. DME: AV(}— 2_ Z APPLICANT's SIGNATURE NOTE: tanuanoe of a zoning permit does not relieve an #Aplioanrs b en to oomply witl7_, 111 zoning requirements and obtain all required permits f m the Boa of Health, Conservtation Commission, Department of Publio Works and other applionble permit granting authorities. FILE # File No. / ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant:_ Address: >- a tN�'1 ► A'YV►S . Telephone: S�S 4-— 3 4-19 2. Owner of Property: 17a H N Address: 0 w1 1 4V1,5 Telephone: 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): 4. Job Location: Parcel Id: Zoning Map# Parcel# District(s): (TO BE BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property 6. Description of Proposed Use/Work/Project/Occupabon: (Use additional sheets if necessary): I V S-FA-L-L t.J o© S --r©Y ' 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 KNOT%'__� _ 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__y _ 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) FILE # AUG 2 5199i - APPLICANT/CONTACT PERSON: � I'/�/� ADDRESS/PHONE: PROPERTY LOCATION: MAP PARCEL: p ZONE -4 THIS SECTION FOR-OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZQNTNCI FORM FULED OUT Fee Pnid 11nildin2 Permit Filled mit New Congtriirtinn Addition to Exis in2 U T OLLOWING ACTION HAS BEEN TAKEN ON THIS APFLICATION. < 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 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 qit fro Co C n Signature of Building ector ffate NOTE:issuance of 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 Publio Works and other applicable permit granting authorities. b O '�"'•t Uq �""fir'�'��, C��D r°nZ M � , b C `b �. `'S ~] N O 00 Cl� O () O Ln o c o I, CD a. o o cr y •..m'cot ft 5 0- o� t-ps o cn rn �o O v' v' p w �l ril '» �, o ' bb x � ooEP � > °� CDbb rt C4 o• 3 ' � 0 o Q aof" c H. 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