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35-113 (2) tfi v �_• r a Z _a Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MASS. q15 © 19 Additions APPLICa ATION FOR PERMIT TO ALTER Repair Garage 1. Location 3 LI C4 h i 1Iah-c, Ter-, ]] Lot No. 2. Owner's name L Address S ��1j. 11a ne. Ter: 3. Builder's name AJ Address Mass.Construction Supervisor's License No. Expiration Date 4. Addition '�''�'D��0 �flo< 9, X I t) 5. Alteration , Io i► 6. New Porch /V 0 7. Is existing building to be demolished? (? 8. Repair after the fire, I / 10 9. Garage N o / No.of cars Size 10. Method of heating /VI 11. Distance to lot lines w4---L16 1 L _� t 7 I) T Reel 12. Type of roof 13. Siding house 14. Estimated cosL- 1 The undersigned certifies that the above statements are true to the best of his, her knowledge and belief. 1 Signature of responsible app,icani Remarks Ili-AMP 0 � � attl lasaxc}tnsctta efl e° DEPARTMENT OF BUILDrNG INSPECTIONS 212 Main Street ' Municipal Building 'a Northampton, Mass. 01060 ' WORE{ER'S COMPENSATTON INSURANCE.AF'ED)AVTT Llt ��_ with a principal place of bit iness/residence at: Z (stmt/ ty/statrJzip) � do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following woritier's compensation coverage for my employees wortng on this job: (Lnsu=cc C4rnpany) (Policy Number) (Expiration Date) ( ) 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: (Name of Contractor) (Insurance Compary/Poticy Number) (Expiration Date) (Name of Coutractor) (Insuraucc Cotnpany/PoLicy Number) (Expiration Date) � 4 (Name of Contractor) (Insurance Company/PoUcy Number) (Expiration Date) (Name of(--ontractor) (Insurance Company/Policy Number) (E)piration Date) (aciach additicaat shod ifnoccn,ry to indudc kdbnnatioo pert d.jng to all 000hadors) ( ) i a sole proprietor and have no one working for me. (I am a home owner performing all the work myself. NOT E;please be asrun that while hommvo=who employ pc=m to do mxiat_t ___•• • ooasuvctioaar repair work on a dwctliag of ant m00 than throe units is which the homoowaa'mid«or oa tho grounds spputtenvA tb=w eras;not gcoaraRy coarndemd to be anploym under the workers compcns4ca Act(GL,152,ss 1(5))�,application by a homeowner for a Gccnse or permit may evidence tho legal avchm of an employer under tan Workeea CompaosWon Act_ I undmund data copy of thin cutcmcnc may be focanudud to tqe Dcpwt ncot of IndLL*iai Aeddea&Ofoo of lu unaoe foe the covemga vet'ificd on and that failure to watt covcmV under section.25A of MGL 15Z coq lead to tha imposition of aimkftl penalties comistmg cf a•Sao of up to 51,.500.00 mdlor i vresoomeat of up to one year and civil p=46cs in the foam of a Stop Work Order and a 5no of 5100.00 a day aggaA Me Foe&Parfin= xl uao ody Peimit Number yLjo ley# Lot# Of Ltoc nsce(N t tee _ + ` �assxcl�uattla of Niarillamp fail I IMPARTMENT OF BUILDING INSPECTIONS I 2 b•Main Street ' Municipal Building INSPECTOR � °�� 21 ` , p g _ Northampton, Mass. 01060 J HOMEOWNER LICENSE EXEMPTION (Please Print) DATE: JOB LOCATION: 36— 113 (Map) (parcel) ( Su division) HOMEOWNER: ' (Name & Addres ) !A 4 a0 to 24 22 3 (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 BUILDING PERMIT # p t 11998 DREWSEN DRIVE 90.01± -, 1 15.71'± W -- ._ _............ LOT 4.5 - C� f i� HOUSE � Y 0 W S-WAY' • QUY-MVE -1 GAR f s C�' � 2 �" 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 IF YES,describe size,type and location: 11 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. This col— to be filled in by the Building Department Required I Existing Proposed By Zoning Lot sizes-C� Frontage lc;);, S Setbacks `a - side L: R: L:2R:=70 rear Building height Bldg Square footage �� ( El 64 %Open Space: (Lot area minus bldg &paged parking) Myyn 17 0 o # of -Parking Spaces # of Loading Docks /V A Fill: -(volume--& location) IV14 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. DATE: -71T8 APPLICANT'S SIGNATURE NOTE: lasuanoe of a zoning permit does not relieve an ioant's burden to oomply witfr oll zoning requirements and obtain all required permits from the Board of Haalth, Conservation Commission, Department of Publio Works and other applionble permit granting authorities. FILE ,f` 'l �I 1 11998 J File No.96 t ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: L N n n &u&hae, Address: �,h�� I^an��P7-7e r" Telephone: irj$5—,�7,2 3 2. Owner of Property: %'5t r)n e— Address: Telephone: 3. Status of Applicant: ✓/Owner Contract Purchaser Lessee Other(explain): 4. Job Location: C�( %✓C�.I�� L = LY Parcel Id: Zoning Map# Parcel# District(s): 5 (TO BE FILLED IN BY THE KUILDING UEPARTMENT) 5. Existing Use of Structure/Property ',Q 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): tw- 0 Q G r 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? / ,7f -4r z5hed NO r6 d DON'T KNOIA' ✓ YES IF YES,date issued: r ee k-) da?7 knotxj 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) 6 ,. FILE .,APPLICANT/&ONTACT PERSON: ce �. "ADDRESS/PHONE: PROPERTY LOCATION: MAP PARCEL: ZONE THIS SECTION FOR-OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE Iffijildin2 Permit Filled njit O New Cnn-,trjirtinn ArresynryStoirtime 14— P, nsInchided- C/ v TH.efOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION: <' V 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 Health Well Water Potability-Bd Health Permit from Conservatio ommission Signature of Building *or D e NOTE:Issuance of a zoning permit does not relieve an appiioant's burden to comply with all _ zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Department of Public Works and other applicable permit granting authorities. 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