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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No:.5^ 3 -3' Alterations
1 - Additions
NORTHAMPTON, MASS. X _19fL
Repair
' APPLICATION FOR PERMIT TO ALTER
Garage
1. Location I,b lei Lot No.
2. Owner's name �s i�'� 7C � Address
3. Builder's name ��vrl`c•.,,� ���c��']c3:� Address
Mass.Construction Supervisor's License No. — Expiration Date
4. Addition /'/' x
5. Alteration WA
6. New Porch ./l11
7. Is existing building to be demolished? �
8. Repair after the fire 41
�� 1 v�' � •�,�✓�
9. Garage X,S!! No.of cars Size /
10. Method of heating � .1
[5'ff t...�c 3 r (/,U�`' % ro 1" C0 �
11. Distance to lot lines / / ^�-�l
12. Type of roof `.�. f 4� �.c11 s c� ZW,� S i� fl� a P �c=�'.c4
13. Sidinghouse ��it t C��s� r�e� � f �, Si,'✓� � �
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible appicant
Remarks
OQ'�x�pTO o�
of Nort amptan
$ �lasaacflnsetta
F9 F DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORI{EWS COMPENSATION INSURANCE AFFIDAVIT
L U?��r4
(licensee/permittee)
with a principal place of business/residence at:
r / _
(phone
(street/city/state/rip)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an 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 or homeowner(circle one) and have hared
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional shed ifneamuy to include information pertaining to all oodrsdors)
( ) I am a sole proprietor and have no one working for me.
(-),4 am a home owner performing all the work myself.
NOTE:please be aware dust while homeowners who employ persons to do maintenance,comuuctien or repair work on a dwelling of
not more than thine units is which the homeowner resides or on the grounds appurtenant thereto are not genially wondered to be
employers under the worker's compensation Act(GL152,ss 1(5)),application by a homeowner for a license or permit may evidenoe the
legal clah, of an employer under ttta Workoez Compematioa Act.
I understand that a copy of this statement may be forwarded to the Department of In&ustrisl Accidw&Oflioe of Imuranoe for the
coverage verification sad that failure to secure coverage under section 25A of MGL 152 can lead to the imposition of criminal penalties
oomisting of a fine of up to$1,500.00 anNor of up to one year and civil penalties in the form of a Stop Work Order and a
fine of S100.00 a day against ttte
Signed this f% �aclay of a r ' 1995 For del nae only
Permit Number
Map# Lot#
Signature of LicroseelPermittee
0 0
B �iinsearl�uerlle MAY ��� j I DEPARTMENT OA BUILDING INSPECTIONS
INSPECTA 212 Main Strcct ' Municipal Building kv
J Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
_ ( Please Print )
DATE
JOB LOCATION :
(Map) ( Parcel ) ( Subdivision)
HOMEOWNER: X '' 9 7<' ra��f
' ( Name & Address)
� � _� 3
( Home Phone ) (work Phone
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one ( 1 )or t�•.n (2) farm 1 ies and to allow suc`
homeowner to engage an individual for mire who does not possess
license , provided that the owner acts as supervisor . CMU80 Section 109 .
DEFINITION OF HOMEOWNER: Person ( s ) who own a parcel of land o:
which he/she resides or intends to reside , on which there is , or i.
intended to be , a one or two family dwelling , attached or detache,
structures accessory to such use and/or farm structures . A person wh
constructs more than one home in a two-year period shall not b
considered a homeowner . Such "homeowner" shall submit to the Buildin
Official , on a form acceptable to the Building Official, that he/sh
shall be responsible for all such work performed under the buildin
permit .
As acting Construction Supervisor your presence on the job sit
will be reouired from time to time , during and upon completion of th
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 fc.
injuries not resulting in Death ) of the Massachusetts General Lai-,
Annotated , you may be liable for person ( s ) you hire to perform work fc
you under this permit .
The undersigned "homeowner" certifies and assumes responsibili '
for compliance with the State Building Code , City of Northamptc
Ordinances , State and Local Zoning Laws , and State of Massachusett
General Laws Annotated .
-T
HOMEOWNER SIGNATURE' 'y-
BUILDING PERMIT #
i 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:
I1. ALL INFORMATION MUST BE COMPLE'T'ED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This colamm to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks -frnnt
- side L• R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
' &paced parkingi
# .Pf. Parking Spaces
f fof Loading Docks
Fill:
vollime--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
y
DATE APPLICANT's SIGNATURE �J � --`° ,/
NOTE: Issuanoa of a zoning permit does not relieve an applioanYs burden to oomply%m tK4 .4ikU-
zoning requirements and obtain all required permits from the Board of Health, Conservotion
Commission, Department of Publio Works and other applioabla permit granting authorities.
FILE #
MAY 2 1997
J
l'i `F File No- 96 01�1/ b �
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: r r r / Telephone:
r'
2. Owner of Property:_X , 7L L142
Address:T� / �� fig f '�r Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(ex/plain`):
4. Job Location:
Parcel Id: Zoning Map# �g6 Parcel# District(s): . &/2A
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property_ /Qe-s jPN,lE,�_
6. Description of Proposed UseMork/Project/Occupabon: (Use additional sheets if necessary):
/J S �,. �t S c✓/ l�t/2� i G2 U�' 174
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 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_J "I 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)
2
96
FILE #
190 `
�
MAY �LICANT/CONTACT PERSON: ,( %� ,t-t�}'l_ V-23�3
? I
ADDRESS/PHONE:
PROPERTY LOCATION:
MAP 3 PARCEL: ZONES
THIS SECTION FOR-OFFICIAL USE ONLY:
PERNIIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM Eff LET) OTIT
Fee pnid
Building Permit EjUed qut U �� t/
1RPmndPlin2Tnterinr,4�2,yJ- 9- -e-t
Additinn to Existing -A�
OLLOWING 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 Healt Well Water Potability-Bd Health
it C-stye io sion
,5
z
Signature of Building for D to
NOTE:Issuanoa of a zoning permit does not relieve an appiloanta 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 appiioable permit granting authorities.
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