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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. =rb y -"'>n JX� Alterations
NORTHAMPTON, MASS. 4�"- 19a _ Additions
APPLICATION FOR PERMIT TO ALTER Repair
a
Garage
1. Location Lot No.
2. Owner's name v ,I e% 14& 4-C Address E/yr ,/l 6-,xa— �
3. Builder's name :zl,, ,r Address <: zz�j=.
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
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 '/, h yL --{e
14. Estimated cost:- >qo v
The undersigned certifies that the above statcmenis are we to the best of his, her
knowledge and belief.
Signature of responsible app,icant
Remarks ✓J /� l (rrJ f. i�y. �S C? ,.s —v c' ;� ZL�f a
O�TT fP�0 o \1 \
eCrz# nf 'Nartijail1 Malt
` " �ixsexcituertte
d DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
DATE:
( Please Print )
J���, �_� /
JOB LOCATION:
(Map) ( Parcel ) ( Subdivision )
HOMEOWNER: k � -t-ft .. �,t
e
(Nam & Address )
S� >
( Home Phone) (Work Phone )
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one ( 1 )or tt-,o (2) fami 1 ies 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 _ .4244Y7
BUILDING PERMIT #
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�xasarhnscice -
m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060 `
WOMCER'S COMPENSATION INSU ANCE AVIT
(li�nsr/per-av ttc )
with a principal place of business/resideoce at:
e Y (ph000l) "7 1 v
(a Tc i/U6 h/stair/2�P)
do hereby certify, under the pI_im and penalties of perjury, Thai:
( ) I am an employer providing the followu)g t,:orb,ers compcnsadon coverage for my
employees wortdng on this)ob.
(Lasuronc-- Company) (POLiey t"'umbet) (Expiration Datc)
( ) 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:
(NaMC of Contractor) �as rangy Cornpa ,/Poky Number) (Expiration Datc)
(Name of Coorcior) Rasurancz Company/Policy Numixr) D2te)
(Name of Contractor) - jnsuranc�- Compaii),/Pobcy Numbu) Dalc)
(Name of Contractor) (Laau-ancti CompaLty/PoL cy Number) -- (EXpiradon Date)
(t e3 ld ti teal c oet
Yo eex ry to c v a o n�oa pe—imnrg to all ec tr GOB)
O I am a sole proprietor and have no one worming for me.
am a.home owner performing all the work myself.
NOT£_ple be—Lm that wbilo b0MCON D Hbo employ persooa to do :••t,,,, :, ooas'.ructioa or rcpt work oo L d-.c g of
coc mote th-.n throo uaiu in which the botnoowacr rtado oc eo the Uouodl zplxtrtcaiat tkxrdo arc ooc gcna-ally 000s-c-d to be
--ploy—under tbo workct`t.oempcnstim Act(G L152ss 1(3)1 applica6oa by a boc cow=far a GcCWC oc perma may cv dmcc 11)c
legal rtstw of La cmployt<under ciao Works eg Compom Ltioa AC_'
l undcrntxnd Ihai a copy of this—1--i may bo focvwrd ed to tbo Dope mot 0t5oo of la urzooa for 0-
oovcngc Va-LGCatioa and that failure to"am mwn,a6,under sccd a 25A of Mal,132«n kcd to tbo impor oa of cri-;nA p=z1bcs "
oom iitzug of a.•fzae bf ttp to S 100.00 md/or unpritomnxai oCup to ooe yar Lod ovil paa.Itio in tfie form oC n Stop Work Order and a
6W O(5100.00&day Lvdm me-
Signed this �', day of' 1997 For dcPutnxn--1%-oaly
Pertn.il Number
Lot 4
• SignaQsc o�Li �. crmitt.cc
10_ Do any signs exist on the property? YES NO X
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES NO_,�C
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This color= to be filled in
by the Banding 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)
f Parking spaces
f %f Loading Docks
Fill:
_(vol-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 �-
1'' NOTE: Iss noe of a zoning
g permit does not relieve an applicant's burd n to comp�VwWrwh",',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.
FILE #
File No.
1
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: \",.a 1r:
Address:_ A:4z�n '� Telephone:
2. Owner of Property: e ', v
Address: � /� N,�-s� Telephone: 6—:i-4.1 --
3. Status of Applicant: k weer Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# X Parcel# f District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Prope ' ,--
6. Description of Proposed UseMork/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/Vadance/Finding ever been issued for/on the site?
NO DON'T KNOV%' >c YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW x, YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO X 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)
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' S �► FILE # U 9 4
APPLICANT/CONTACT PERSON:
ADDRESS/PHONE:
PROPERTY LOCATION: Ile
MAP_ PARCEL: ! ZONE
THIS SECTION FOMFFICL&L USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DA
ZONING FORM Eff.I.E.1) OUT
v a G!
Fee Pnirl
c�
Fee Pnid 42
wi a of C'nwtnirtion-
Arreccnry Strnrtnre
t e
3 Sek of Pinns /Plnt Plan
THE LLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION-
Approved as presented/based on information presented,))La j,; I rf
u
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 Conservation Co ssion
Signature of Building Inspector ate
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, 13epartment of Public Works and other applicable permit granting authorities.
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