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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location / %� 1-4 (� C_(>c��� 7 f- L U"����L �, Lot No.
2. Owner's name C-- /� 15 T-6 ���f E/,' t' T0 '/ )Address A,U'
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
t
4. Addition --
5. Alteration
6. New Porch
7. Is existing building to be demolished? ,1 (r,
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof +c, l —
13. Siding house
14. Estimated cost:-
G� The undersigned certifies that the above statements are true to the best of his.
knowledge and belief.
sig ture of responsible app.icant
Remarks
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of Nortfluillptoll
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4: DEPARTMENT OF BUILDING INSPECTION 1v U
INSPECTOR 212 Alain Street ' Municipal Bui1
Northampton, Mass. 01060 1. � �►�
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HOMEOWNER LICENSE EXEMPTIO
(Please Print )
DATE: f / � ,'
JOB LOCATION: G�
(Map) ( Parcel ) ( s bdivision)
HOMEOWNER:�. � ,,1 5 i -,"/V z_, );1`t_-" '-r
(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.
HOMEOWNER SIGNATURE ,� _ _ L, A
BUILDING PERMIT #
�04��ca�5t�T0 ,
s l wart foil
� 1919,
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DEPARTMENT OF BUIL)WG INSPECTIO
212 Main Street ' Municipal Building
Northampton, Mass. 01060 '
'YORKER'S CONMENSATION INSURANCE AYFIDAVTr
(lic--nsec/pemvttc,^) —
Nvitfl a principal place of business/residence at:
(str�t/ci ty/sue is/a p)
do hereby certify, under the pains and penalties of perjllry, t11a t-
O I am an employer providitg tfie following vVor':er's COtl1penS3t]on cove age for my
employees workmg on tlllis job:
(Insure= Comps-ny) — -- (Polio Number) J (F—piration Date)
(/,)'1 am a sole proprietor, general contracto or homeowner;(circle one) and have hired
the contractors listed below who have the foilow_ng s compensation policies:
(Name of Contractor) (Lusurance Company/Pok—j Numlxr) (Fa-pim6on Date)
(Name of Contractor) (Lasuranc:. Compauy/Po!ic;Nunioer) (Expiration Date)
(Name of Con-tractor) (Li_uran(° Compaay/PoLcy Nurr,_jxr) (Ex-piration Date)
(Name of Contractor) aamrance Company/Poky Number) (Expiration Date)
(att„a,additioa�d short ifnocr ry to cx}i�dc shoo pertn Wing to nil ooarncton)
( ) 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 awzre that whilo hemcovmcra wbo cmpl ay pczo=to do mamica3rx,oDmtu oa or repair work on a dwclliag of
not moon than thnx units is Which the hoamv ncr r=dea or oo the gourds appurtcoaat tbtrt arc not I; o, ally ooandcrcd to be
cmptoyrrs under the-Orkcr 4° cn Act(GL152,zs 1(5)�applicaboo by n homcoavcs for a Gce>zx cc permit tray evil the
Icgal rt2tw of an employoc uodortho Wockods Conzpomatioo Act
I understand that a copy of this r trnx xf may Lo forw<u dad to tbo Deparm of Indiel A.6&a&OtSoo of L=u anoo for the
coverage vaificaiou and that failure to scatrc covcrnso undo soctioa 25A of MIL 152 can Icad to tbo imposition of criminal pcnal -
000=tmg of a fine of up to S 1,500A0 and/or imprisonment of up to ooc year and civil pamhja in the form of a Stop Work Order Ind a
fim of 5100.00 a day against mc.
Sign this 7—day of 1 0 1997 For dcputa c Lo poly
n Permit Number
Map4 Lot#
Signature of t crmittcc
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10. Do any signs exist on the properly? YES NO
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the properly?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 cols to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks S
- side L: 3y R: L: _R•
- rear
Building height G '
Bldg Square footage 13 � % r 3� %/ % / 3b to
V-1 L
%Open Space:
(Lot area minus bldg
' &paved parking) /0 ZQO s '
# o f -Parking Spaces (/
of Loading Docks
Fill:
4 vo1-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
1
DATE: APPLICANT'S SIGNATURE ���_� � 4"
NOTE: 9dmu#nao 46t a zoning permit does not relleve an applloan s bur. en to oomply
s withl,.+ell
zoning requirement and obtain all required permits from the oard f Health, Conservtation
Commisaion, Department of Publio Works and other appliomble permit granting authorities.
FILE #
`
JUL 1 4 1997
\
File No'
DEPT OF T'i
v� ��� �� � �
~~~,�,~~~,~, =_°�~,~~~,_� ���^, ^���~���,�_~~��" « ��.�w" . w��
PLEASE TYPE OR PR[YT ALL ZXFORMATZON
1' Name -' Applicant:
Add / 0 -
2. Owner of Property: 1
Address: /mphone
3. Status wJApplicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning yNap# - Parcel# District(s):
(TOBE FILLED |NBY THE BUILDING DEPARTMENT)
S. Existing Use of8tructune/P rope dy /
G. Description of Proposed Use/Work/Project/Occupation: (U additional h if
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed P|ano
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
B. Has o Special Perrnit/Vohanoe/Finding ever been issued for/on the site?
NO L/' DON'T KNOW YES IF YES,date issued:
IFYES: Was the permit recorded ot the Registry ufDeeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document
8' Does the site contain a brook, body of water orwetlands? NO L '' DON'T KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs bobe obtained Obtaineddate issued:
-
'
(FORM CONTINUES QN OTHER SIDE)
'
-
' 4 (997 rzL> #
)EPT OF SUGMIPN ;I'%/C. NTACT PERSON:
N— a— —"`::: a NE:
JPROPERTY LOCATION:
' VIAp PARCEL: f (P ZONE
THIS SECTION FOR—OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FH,T,FD OUT
Fee pflifi
Buildin2 Permit Filled nut
A(Mition to Existing
z.
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
\ , Approved as presented/based on information presented
X Denied as presented:
Special Permit and/or Site Plan Required under: § 10.1 D) 16,
_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 Server Availability
Septic Approval-Bd of Health Well Water Potability-Bd Health
lPeruiUJrom Conservation mission
Signature of Building for to
NOTE:lasuanoe of a zoning permit does not relieve an appiloant's burden to oompty with ail
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.