Loading...
29-052 (2) a 70 'v Z � y O Z p Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. _ Alterations NORTHAMPTON, MASS. 19__ Additions APPLICATION FOR PERMIT TO ALTER a Repair Garage 1. Location \ �, \�l O.� R O'tt U-n CQ Da�� C\1 ��C�'� Lot No. 2. Owners name C cm-\ kXbf\,5. (\C+ .>,,t e--�AAddress �\\V)a\(�'C 0 �[0 V� . cvsC�� 3. Builder's name Address Mass.Construction Supervisor's License No. Expiration Date -4. Addition (�—`i��"� L3�'�C`.�'� 1 (i�` r;� �i: L) 0 7 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 t 11. Distance to lot lines "� ,� �� ' 12. Type of roof tee_tz__ a 6 — 13. Siding house -44. Estimated cost:-i r The undersigned certifies that the above statements are true to the best of his, her knowledge and belief. Signature of responsible appicant Remarks 0 APR 1 5 1998 s � .8 �Z�7 � �LtZ'��ji1I1t�1�1ITi - � � �lxsaxcflasctts ern DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT You�Is with a principal place of bu-ne esiden�ce at: (str�f/city/stafrizip) -- _—_-_. do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following workers compensation coverage for my employees working on this job: (Insurance Cori]i=) --- --- (Policy Number) ---- (Expiration Daze) I am a sole proprietor, general contractor o homeoD(circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insuran(—_ Company/Policy Number) (Expiration Date) (Name of Contractor) (insurance Company Policy Number) (Expiration Date) (Name of Contractor) (Insurance Compauy[Pohcy Nurnbu) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional shed ifneocauy to include iafuanatiou perta=no to all ooatzadotz) ( ) I am a sole proprietor and have no one worlang for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that whilo homeowners who employ persons to do�it*tMxnce coasbvction or repair work on a dwelling of not more than throe units La which the hombowncr resides or on the grounds appurtenan1 tbercto are not gmcally ooandc-d to be employers undotr the works compensation Act(GL15?,ss 1(5)�application by a homeowner for a license or Permit may evidence the legal ctahss of an employer under the Workeet Compemat ion Ad. 1 underhand that a copy of this uatemeat may be forwarded to the Depart nm of Inkut nd A=draeY Offioo of ln%xKDce for the covaxgo verification and that failure to seatre 00%,cmgo under section 25A of MOL 1:52 can Iced to the imposition of criminal Penalties oo-isting of a fine of uP to S1,500-00 and/or of up too=year and civil paaltics in tbo form of a Stop W ode Order and a find of 5100.00 a day agnirsst me. For dq=ftn W use only G Permit Number �• ���A Mali �.Lot# i of icy nsee/Permittce e a APR I Crz# of Nbrrf4all, �aiY p 5j pQ M. I �./ ►990 �nSa:{GI�iISt!(n 5' DEPARTMENT OF BUILDING INSPECTIONS ""�"` ._: Main 212 Mi S ' Municipal Building INSPECTOR � :.._. p g Northampton, Mass. 01060 " HOMEOWNER LICENSE EXEMPTION (Please Print) DATE: �� ��- q JOB LOCATION• (Map) (Parcel) (Subdivisio ) HOMEOWNER: a-g-. a. , (Name & Address) ( Home Phone) (Work Phone) The current exemption for "homdowners" 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 SIGNATUREc BUILDING PERMIT # s 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_Z 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 Building r.eepnrtment Required Existing Proposed By Zoning Lot size q6/ k 9, 6./'r Frontage (D ( ��� Cv C- Setbacks - frnnt F''" 3 �`' ` n - side L: 9�6 R: SID L: R: 2 >l - rear Bldg Square footage S r %77 Space: ot are gnus bldg paved par . ' \ # of -Parking Spaces ht of Loading Docks Fill: Avolume -& location) 13 . Certification: I hereby certify that the information contained herein (,1 is true and accurate to the best of my knowledge. _ DATE: �-A- k--)� . 1 s APPLICANT'S SIGNATURE NOTE: Issuance of a zoning permit does not relieve an plioan s burden to oom ly with all zoning requirements and obtain all required permits f�a the Board of Health, Conservation Commission, Department of Publio Works and other applioable permit granting authorities. FILE # b APR 1 5 1998 File No ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: . C) \\\ I",\ \' ►J�Q� _ Address: V—\ ('S Telephone: ms �Q_ C( V 2. Owner of Property: Address: r rCl Telephone: 3. Status of Applicant: ���Owner _Contract Purchaser Lessee Other(explain): 4. Job Location: Parcel ld: Zoning Map# C� Parcel# 1,5 C-9- District(sl'y �11 ta' o (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property � 6. Description of Proposed Use/1Nork/Project/Occupation: (Use additional sheets if necessary): V\X � ax\ cab Q(Y�Gv 0 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 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'—Z 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 APPLICANT/CONTACT PERSON: 'ADDRESS/PHONE: PROPERTY LOCATION: ,! MAP PARCEL: a'SoZ ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERNUT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM M,1F ED OUT Fee Paid C, v New Cnnqtrjirtinn .Remndeling Interior Dian Tnrhided- L��Occijpant Statement or Lirensp;� ✓', TFOLLOWING 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 nservati o mi Signa uil ector 6ate NOTE:losuanoa of a zoning permit does not relieve an applicant's burden to oompty with all _ zoning requirements and obtain ail required permits from the Board of Heaith. Conservation Commission. Department of Publio Works and other applicable permit granting authoritles. vow_--, o �C n O o 'd .s.r' i! N �P (p O O � '�tpp• a � G7 � N f Vi y O r- r• r-] b.b 6 o O n 7 p H N "hOb N N LT! 5 ' o n a 0 CD o .11 c ca I�• LQ o a.�T ' o� n c H, na 4 5 Q tn 9 — LO CD � O m fi g ' ° 1 vim, R = CO r+ O W Ot 0 51 co U'Q O 3 'z7 �• � o .." cra 'c7 c O, En o�I a ° -11 tz CD o ac ° r- o CZ ° B ° N © o trC (�7 x o' o R CD