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29-126 (2) a v v o m NIX 3 C Z m ... > cn O r Z Fri A Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. X°��l�� Alterations a ri� : NORTHAMPTON, MASS. DC 4(1 1 Additions APPLICATION FOR PERMIT TO ALTER Repair Garage 1. Location ' '� C f = E4,0 F AA C Lot No. 2. Owner's name 0'1f t� 1-ff1j cx_ J Aa n ,/Y),; �,t. Address /0 4 4e f o C T � 3. Builder's name Address Mass.Construction Supervisor's License No. Expiration Date 4. Addition 5. Alteration S 7-Kl ' k'oof 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 s 10l1/9 L 13. Siding house 14. Estimated cost:- / The undersigned certifies that the above statements are true to the best of his, her knowledge and belief. l'iU ._. Signaturt of responsible app,icanl Remarks 04(ttAMp� OCT 71997 Cr f a #4ttntp urt . k OF BUILDrXG INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT (Ii censee/permittee) with a principal place of business/residence at: /0 A lgrly G _F4v n1�A)C.s:t_/Y7,1� , 0/06 =t, (phone#) (street/ci ty/sta try a p) do hereby certify, under the pains and penalties of peglify, that: ( ) I am an employer providing the folloWmi g ,worker's compensation coverage for my employees working on this job: (II11=cc Coutpany) (Peiicy Number) (Expiration Date) (,,,<I am a sole proprietor, general contractor o omeowner circle one) and have hired the con-actors listed below who have th.e following worker's compensation policies: iIl jr ,¢,) °vN ( �/ �,- �5' . - , s . (Name of Contractor) (Insurance Comparry/Poticy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance CompauyiPolicy Numlxr) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additicenl shx Tnect-_m r to include mfoniutica pertaining to all coatrac on) ( ) 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 homeowncn Nebo=play painns to do m.mt�mnstrl t oa or repair work on a dwelling of not more than throe units is which the homeowner resides or oa the grounds appurtenant thereto are not gaxrally ooctiukrcd to be employers under the worker's ocmpcas4oa Act(GL152,zs 1(5)),application try a homeowner for a license or panes may evidence the legal ctatua of an employer under thn Worker&Compemation Act I understand that a copy of thin etatcmeat auy be forwartW to tbo Dcpcutaxo2 of I.&L trial A zid—&Ofriw of Iz�for the coverage verification and that failtn-e to secure covcraga udder secdoa 25A of MOL 152 can lead to the imposition of a musk penalties comisti of a&ne of up to S1,500.00 snigger•imprisonment of up to one year and civil peaaltia in the form of a Stop Work order and a fora of 5100.00 a day against= Si ed this day of C 199jr For dcpQtar�ni use onty ( � Permit Number Map# Lot# Signature of itic=sS&ermittee aril tt»i fait OCT 7199-( I . yA38 ACI1IIII[IIII DEPT Of 6 t ''i�7EPARTMENT OF BUILDITjG INSPECTIONS - ° """'"'°` 212 Main Street ' Municipal Building ' INSPECTOR P g Northampton, Mass. 01060 HOMEOWNER LICENSE EXEMPTION (Please Print ) DATE: CC-taber �„y, J 5/� JOB LOCATION: ,T (Map) ( Parcel) ( Subdivision) HOMEOWNER: fi%S I-')e/,' c/Z- _1' , (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 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. t HOMEOWNER S I GNA ✓` �L___ BUILDING PERMIT # 10. Do any signs exist on the property? YES NO TW 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 fi22,ed in by the Building Department Required I 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) # of Parking spaces of Loading Docks Fill: 4 vol-lime--& location) 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. _1 APPLICANT's SIGNATURE NOTE-. Issuanoe air is zoning permit does not relieve an applioant- burden 16 oomply wlttl,. U zoning requirements and obtain all required permits from the Board of HXalth, Conservtation Commission, Department of Publio Works and other appliomble permit granting authorit;es. FILE # OCT 7 W7 File No 91 j t ZONING PERMIT APPLICATION (§10 . 2) �► PLEASE TYPE OR PRINT ALL INFORMATION Name of Applicant: k L^ /Address: ��1 Telephone: = �� 2. Owner of Property: '5Am Address: 5 ice/y1 r Telephone: 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): --'4. Job Location: Parcel ld: Zoning Map# Parcel# District(s): (TO BE FILLED IN BY THE BUILDING DEPARTMENT) S. Existing Use of Structure/Property 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): 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 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 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) FILE it 2RTA 7 W E APPLICANT/CON'Tr .CT PERSON: DEPTOM p ,490 J as i L PROPERTY LO ATION: N1�AP c2 Y PARCEL: ZONE THIS SECTION FOR-OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM VU,T,FD OUT Fee Paid ]Rnildin2 Permit Filled apt ,'— �...� Addition to Rykfing Tnrhyded- (�-fq nt Plans /Plot Plan 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: § 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 !Permit from Conservatio ommissiow j xe 9 Signature of Building Ingoffor Date NOTE:issuanoe of a zoning permit does not relieve an applioant's burden to oomply with all zoning requirements and obtain all required permits from the Board of Health, Conservation Commisslon, Department of Publio Works and other applioabie permit granting authorities. � b z noq �.'+►.av o � � ('> N CD 00 A� ►y, r. r o o � x �, rt � � d ° � � � p ` 1 V1 �• w G n o d fD 1 C)C) UQ o CD v� 0. sss Z y I ro d r CY c cr.... =r. ° O Zs cr l 1 O aOQ O ° ] O ° O IJ c�i� 5 5 5 O 00 b "b Cn bC J O O �� � �• � � � L� � � I m � w N � o 7n �n O ° c 5 o �, o T o v' o g. b r� cu c. °c �. c. ?. c° a' ►� a o w o o o °5° o.