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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. l Alterations
NORTHAMPTON, MASS. J U &-V / _
19 / Additions
APPLICATION FOR PERMIT TO ALTER Repair
1
Garage
r
1. Location `1" y/�!J �! l & n Lot o.No.
2. Owner's name �O �L�!L-� Address_/ � E3 4--A�' f'/ 7r-
3. Builder's name .SA/P5 007220,2k /QC'GES�/ Address
Mass.Construction Supervisor's License jo. //A'�/�(/li "J AJ Expiration Date r
4. Addition PU TT`! A3(S / 2' �' Q Ul L.7— , AdiS y
C' Ls� //J /`l f -D
5. Alteration
6. New Porch
7. Is existing building to be demolished? d
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating N y A-) 65:r-
11. Distance to lot lines_J�-s P ee7-k C 0 `,�' !�-i ��!/VC
12. Type of roof cam /A)6 fLe—
13. Siding house /U
14. Estimated cost-
®� The undersigned certifies that the abo s ments are true to the best of his, her
knowledge and t
Signature of responsible app scan
Remarks
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$ AL 91997 Z '
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DEPARTMENT OF BUILDING INSPECTIONS -
INSPECT 212 Main Strect ' Municipal Building '
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE:
JOB LOCATION:
(Map) ( Parcel) ( Subdivision)
HOMEOWNER: O
�� �` r (Name & Address )
l2/ 7 3 lE
fj f06oti ( Home Phone) (Work hone )
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 m_ ay 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 Annotate
HOMEOWNER SIGNATURE
BUILDING PERMIT #
2o�KT� __..L
AL 9 1997
asaacyttsclta
",DEPARTMENT OF BUILDWO INSPECTIONS
Main Street Municipal Building
Northampton, Mass. 01060
WORICER'S COMPENSATION INSURANCE AF AAVIT
L) 4:7-
(li inset'/permi tt ee)
with a principal place of bU ness/residence at:
=L.O n '��Cl
� � ��4� A60�� Pr 7- /' V - '41d eIM Z(pbonet)
(SU=Vcit)'/stalfhz p)
do hereby certify, under the pans and penalties of perjury that:
O I am an employer providing the follo%ving wor'.er's compensation covet.ge for my
employees worming on this job:
(Insurance Company) (Policy Number) (Expiration Date) '<>
I am a sole proprietor, general contractor homeowner circle one) and have hired
e contractors listed below who have the following worker's compensation policies-
6-k 1 As o u TvdoR
(Name of Contractor) Omsuan(-- Company/Policy Number) (Expiration Date)
(Name of Contractor) (Lnsu any Company/?oLicy Number) (Expiration Dale)
(Name of Contractor) (Insurance Compaay/Policy Numbei) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional rbocc ifnoccairy to inclOdc=-f�oa pertainin.g to alt 000tracton)
( ) I am a sole proprietor and have no one worming for me.
( ) I am a-home owner performing all the work myself.
NOTE:plea=be aware that whilo bomcovrD=Abo employ persom to do nm ii _.,r.-
=_� coasnrc600 or repair work on a dwmlling of
not moce than tbmo unite in which the bomoowucr rrsides or oo the gound_,xppurtensat Ibaxw arc noc gcocrally 000ndcrcd to be
employ=under tho vvorkces.oempcasatica Act(GL152,=t(5)�application by a homnow=for a licca=o<permit may evidence the
legal et—, of an employ=under the worts et Compomat.ion Act
I understand that a copy of thu mtcmcat may be forwarded to the Dtpartr c of la. d Aoad=&Olboo of laau.neo for the
coverage vcrificatioc and that failure to stcu c covcrago under soetioa 25A of MOL 152 can lead to tba'impostioa of tximinal pcmltics -
oomistiag of a fine bf up to 51,500.00 an&CK'impris�ofup to ow-year and civil pcoLhica in the form of a Slop Work Ordcr and a
fine or 5100.00 a day against M--
S igned this y Of_� . 199 7 Fcc dcputmceul u-—Jy
Permit Number
Mao Lot#
Si lure of Liccn5,c&Pcrmittce
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`1Z
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This —1— to be filled in
by the Eailding Department
Required
Existing Proposed Zoning
Lot size
Frontage
Setbacks
- side L: R: L: R: 6�1
- rear Al
Building height
Bldg Square footage f3 /y% U
%Open Space:
Lot area minus bldg �G
' &paved parking) •J
# -pf "Parking Spaces
f of Loading Docks
Fill:
4 vo1-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my kn edge.
_1
DATE: 7 / / 7APPLICANT's SIGNATURE
NOTE: 1 ano of a zoning permit does not relieve an iioanro burden o m , "
P ply.with,rpll
zoning uirements and obtain all required permits f m the Board of Ha , Conservation
Commission, Department of Publio Works and other piiomble permit granting authorities.
FILE #
l► J' 9 WT
gcpt lc- Fi 1 e No.
a
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address44 �1,�7� l / IeF,> 41A 'p' Ere phone:
2. Owner of Property: G'l-IA) 1/ 'IL
Address: �r1 y Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map#Parcel# l District(s):
(TO BE FILLED IN BY TH BUILDING DEPARTMEMT
5. Existing Use of Structure/Property l 1�d / t7 Zi j Z:7 41=
6. Description of Proposed Use/Work/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 PermitA/adance/Finding ever been issued for/on the site?
NO DON'T KNOW 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)
fit , FILE # 962515 6J4C�
JUL I
9 M7
CAM/CONTACT PERSON:
IIr'HONE: r
PROPERTY L CATION: 101-14
MAP PARCEL: ZONE
THIS SECTION FOR.OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FH,T.FD 0111
Fee Paid
Building Permit Filled mit
✓'
ep
Type-, of Constniction-
_Remndelin2 Interior
Additinn to Existing
THEALLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATIW <
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 Conservatio ommissio
Signature of Buil g Ifate
NOTE:Issuance of a zoning permit does not relieve an applicant's burden to comply with all
zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
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