29-270 (3) _I c Z M
.� U, Z
tr > o y O
i Z
v
Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 2 S/' a Alterations
NORTHAMPTON, MASS. 19q-7 Additions
APPLICATION FOR PERMIT TO ALTER Repair
a
Garage
1. Location t" 2 1 oy kaiail pd?- JCL O�'c l�&r-ti Lot No.
2. Owner's name IGtd jUj !Y'u-2-/1&tip! Address_C-7_ 4 d AZ1 : gj Z L2 e,
3. Builder's name U8 41X Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration s ma erg(12L- <
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 1
12. Type of roof PL k/n D o f
13. Siding house
14. Estimated cost:- 14V,
The undersigned certifies that the above statements are true to the best of his, her
knowledge an d belief.
Signature of responsible app icant
Remarks
t r ara
c 3 1
t SArt-.
t
t
If
�o�C �P JOB d f ) r
9 Gxf� af �LV�x
arfljalll toll Z
. Z
�9 a3IIAChttSCttE
p
m DEPARTMENT OF BUILDWG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060 �yy
'WORTCER'S COMPENSATION MSURA.NCE AFFIMAVTr
--
(IiceusecJpernvti�}
NvIth a principal place of business/residence at:
-�(� t�— �q
P 6F, pL im ii�hone;f) tSy-7811
(str�t/city/stairh p)
do hereby certify, under the pains and penalties of perjury, ths.=
O I asn an employer providing the follm",ulg v,,O-Ir_er's Coll] tion coverage for my
employees worEng on this job:
(Insurance Connzrry) - -- (Policy Numlx r) (Expiration Date)
( ) I am a sale proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies_
(Name of Contractor) (Insurance Corapany/Poky Number) (Expiration Date)
(Name of Contractor) (Insurance Cornpany/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Coinpaiiy/Pohcy Nuu,_bu) (Expiration Date)
(Name of Contractor) ansurance Co:mpany/Policy Numb---r) (Expiration Date)
(anach abditioail sheet ifnooc=i y to in�informs ion pertain;ng to a 000rzacton)
( ) I am a sole proprietor and have no one working for me.
NA I am a home owner performing all the work myself.
NOTE:please be as arc that whito homcowacra who employ pczsom to do m ;,fm„r,cc masuuc ioa or repair worst on a dwelling of
not more than throo units in which the hom6owncr r=dcs or oa the groja6 app<trtenant tbc, t arc oo(generally oowidcmd to be
employers under the vmdccr`s coapc=satioa Act(GLI52-=1(5)�application by a homeowner for a licacme or permif may evidence the
legal etahrs of an omployx undertho Worlcels Compoosatioa Act.
I un&rxtaad this a copy of this r t--t may ho foci mud4d to tbo Dcpnrtmc of I�1 Ax i8=&Office of Lass w for tizn
covcragc verification anti that failttcc to&taut covcrago under section 25A of MOL 152 can lad to tha"ituposition of criminsl penalties
comisiiag of a fmc of trp to S4500-00 and/or imprison of up to ow-yar and civil pcn&hics is the form of a Stop Work Ordcr and a
fins o(S100.00 a day agztinsL me
J
S igllCd this . 1_day of 1997 For dapartm�s —ooh'
Permit Number
Map# Lot#
igna
0 f i UCC
lorf jalllpfoil
DEPARTMENT OF BUILDING INSPECTIONS =
INSPECTOR 212 Main Street Municipal Building
51997 Northampton, Ma
&N 2 ass. 01060
HOMEOWNER LICENSE EXEMPTION
DATE:
( Please Print )
� 1v�.�/9�
JOB LOCATION:
(Dap) ( Parcel ) ( Subdivisi.on)
HOMEOWNER: �� [,. ��CZ,-M t-s w/ <-17
( Name & Address )
( Home Phone ) (Work Phone )
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one ( 1 )or two (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. UIR780 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 b_uildinq
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 pers,cn( 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 } �.
BUILDING PERMIT #
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.
This cols to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks J'5.0 r
- side L:/G� :&j L:a° ' R: ,30
- rear ,3J 8 �`
Building height t
Bldg Square footage o
�o�D
%Open Space:
(Lot area minus bldg
&paved parking)
.pf -Parking Spaces
h� of Loading Docks
Fill:
Avol-time--& location)
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
_1
D7 'E: z2Jrl APPLICANT's SIGNATURE
f" NOTE: lasuanoe of a zoning permit does not relieve an applioanYs b n to comply wit",all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applionble permit granting authorities.
FILE #
JUN 2 5 07
Fi 1 e No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: a lc.hhE I_. h L0_.N)y-,-S k
Address:15'70 e A&44k 1ZW_ Telephone: X-LV-7`/r,
2. Owner of Property: 14'ri
Address: Telephone:
3. Status of Applicant: _Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: �_f.IL��II��`�✓ �7(�'_
Parcel Id: Zoning Map#-�2y Parcel District(s):�_�lC��
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
' B
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 KNO%'V YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DOMT KNOW YES
IF YES: enter Book Page _ and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO_tl- 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
' jN 2 51997
►s
APPLICANT/CONTACT PERSON: '"7 A�,
pp
PROPERTY LOCATION: -
MAP PARCEL- -
ZON E
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FIT LED ED OUT _
Fee Pairs _
FPP Pain 412-f
�� _ ✓�
—_
�.
THE LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION'
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 Healtjv Well Water Potability-Bd Health
it f It Cgtr�e o Sion y
Signature of Building ector to
NOTE:Issuanoe of a zoning permit does not relieve ani applioant's burden to oomply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Mapartment of Publio Works and other applioable permit granting authorities.
i
ro
z
tm
p 9F O z O 'G
no b O lT7
V� E ° 0 n
C C N
Q'
o
C', c x
C (D �� �� o N rt, ,o
a� R. � E n o
9�b `C d rt c�
m a- �T,
a
o �,• Q, oac, � o14
-V
O ¢ � .
p rr N �
co
c 0 m �-►.
qQ
R < � a� o
O y
0-0 y �
9 tTl �
v� 0 sss
7
l 1 0, �p r fro O 0� O N N
y
z a
ti' r0
j �. � vj �
cn 0 R O
oN �.
Ts cv c° ]. °c o' �'
0 aQ s o as d
►b � � o � ac o � ao � c CD�
OD ] Oz
r�