35-203 (5) -THIS PLAT NOT FOR RECORDING PURPOSES-
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Zoning
V1Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS.
19 Additions
a APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location /2 10 // ' /r // Lot No.
2. Owners name 64 Address 91M C-1
3. Builder's name Lam' Address /
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
14. Estimated cost:
The undersigned c rtifies that the above statements are true to the best of his, her
g
n /� r knowledge an lief.
OZ
�O Signature of responsible app,icant
Remarks
o�-��iAMp�O
s� g APR 3 11998 Crfiaz# ttntrt
9lasaxchnsctta
m DEPARTMENT OF BUILDrNC; INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT(licenserJpeTmit2ee)
with a principal place of business/residence at:
(street/ci ty/qatrhi p)
do hereby certify, under the pains and penalties of pegury, that:
( ) I am au employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor o h o meowner circle one) and have hired
the contractors listed below who have the following compensation policies:
--j�A'W_'Ph06j .- 3 6 4 0�6) 0_�-ol) /o
(Name of Contractor) (Insurance Company/Policy Number) (Expimdon Date)
(Name of Coutractor) (Innurancc Company/Policy Number) (E,\Tirauon Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(nnuh additions):hoer ifnoocnary to inehrde information pertaining to ell ooa r,d )
( ) I ant a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:pteaae be awu=that while homcowocm who employ p,=om to do=datcn3nce,coastrvction or rcpa r work on a dwelling of
WE Marco than throe units in which the homteowncr rc=dcs or oa the Vouuds appurteawi thereto are not ge=ally ooandered to be
0mploY=under the workca oompc:ns4on Act(GL152,s3 1(5)),application by a homeowner for a liaise cc permit maY evidence the
10811 status of as employer under the Wohda Compomaison Ad.
I understand that a copy of this rtatcmcot may be forwarded to tbo Dop&rmuat of In&strial Ar661o&Offroc of Iastrraoce for the
coverage verification and that failure to secure covaago under section 25 A of MOL 152 can lead to tho imposrrion of criminal penalties
oo=siing of a fine of up to S1,500.00 and/or imprison of tip to one year and civil penalties in the form of a Stop Work Order and a
find of 5100.00 a day against Me.
For d —�Y
Permit Number
Map# Lot#
1 SigvahmE of LiccnseelPermit tce
O�g11M!pip
6f# of 'Nortilaily tail
3
APR .GIIASbACI�Udttld
.998
DEPARTMENT OF BUILDING INSPECTIONS =
INSPECTOR - 212 Main Street ' Municipal Building
Northampton, Mass. 01060 "
HOMEOWNER LICENSE EXEMPTION
DATE:
(Please Print)
�T
JOB LOCATION: _ Lfa b ��� to
(Map) (Parcel ) ( Subd' isi "�)
HOMEOWNER-
(Name Address )
egnl 661k 3 f
(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 #
10. Do any signs exist on the property? YES _ NO
IF YES,describe size,type and location: A .® 61* 5-1ra
Are there any proposed changes to or additions of signs intended for the property?YES NO X
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This columm to be filled in
by the Building D�partmsnt
Required I
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L:J<- R: yU
- rear
Building height
Bldg Square footage
%Open Space: _
(Lot area minus bldg 0
&Paced Parksrngi
# of -Parking Spaces
# of Loading Docks
Fill:
_(volune-4 location) --�
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowl
DATE: APPLICANT's SIGNATURE
NOTE: Issuance of a zoning permit does not relieve an pplioanrS burden to comply With all
zoning requir @menu and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioeble permit granting authorities.
FILE #
T;
APR ' .q6 3?/
3 998 f 4 File No
o
ZOATING PERMIT APPLICATION (§10 . 2)
ry`PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: AY2 4 jlk"('i�
Address: S Telephone: 6oW Mx;�--
2. Owner of Property:
Address: Telephone:
3. Status of Applicant: k_Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# Parcel# C�. District(s):
(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):
06V L& 6�oa &L- YAW
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.
S. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNO!^l-_ 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__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)
r
6 �
gi�pp ' �-- �E I
11 FILE if
(�, ?
FAPR 3
"s
19 98
APPLICANT/CONTACT PERSON:
PROPERTY LOCATION: E) f/
MAP PARCEL: ) ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FULED OUT
Fee Pnid
_Fee haid
ly4ie `
Addition to Rxktin2
THE
�,.
.,FOLLOWING 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
did of Health Well Water Potability-Bd Health
Permit from Conservati ommission
3/Z
Signature of Building e for EfaW
NOTE:lunuanoa of at zoning permit does not relieve an applioant's burden to oomply with all
zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commission. Department of Publio Works and other applioabla permit granting authorities.
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