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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. _ >> Alterations
a rNORTHAMPTON, MASS. ,.'�'yr �- �'� y fq !� Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location /� /`,1 LJii u v; << Ul/C> �► � i`v- l Lot No.
2. Owner's name ��� r c y`d z- f - ��r Address /-2 A,Aw exv/'
3. Builder's name f`'�' ? Address � 'ft
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
6. New Porch
7. Is existing building to be demolished? A O
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:-
L' U V The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
!� Signature of responsthLlapp,icanl
Remarks
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BEAM LAYOUT 1, Z RUGG LUMBER CO
CUSTOMER -- MIKE / KELLY 24 W. STREET
DATE 04/27/98 REF KELLY W. HATFIELD, MA
6' 8 3/16"
12' 5 3/4`
A
4' 10 7/16'
2' 53/8
Ll I 1' 6 1/4"
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BEAM BEAM POST POST
LABEL LENGTH COUNT SPACING
A 8' 3 1/80 2 6' 10 5/8'
B 25' 2 1/2' 6 4' 11 13/16'
Post spacing is measured center-to-center.
Depth of concrete footers - 48 inches.
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$ Jffl isaeltusetts
1t+'" 2 4 1'99,�91)BPAItTMENT OF BUILDING INSPECTIONS �
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01060 "
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE:—
JOB LOCATION: r J ;2
(Map) (Farce ) (Subdivision)
HOMEOWNER:
(Name & Address )
Z'z �f u v-„a C: No 5a&-Si 3 b `e S 20 -S_
( 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 responsibi=lity '
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 # «:,
�04C ttAM PLO
F o� !» Gf iQ elf 39art4alilpfQn
r � �asaxc nsctia
DEPARTMENT OF BUILDrNG INSPECTIONS
_._ 212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSA'T'ION INSURANCE AFFIDAVIT
(licenserlpermittee
with a principal place of businesslresidence at:
e` k V41 r/U�,� r—v,�, - (phone#)
(str r (4cy/qa t p) D/ O6 6
do hereby certify, under the pains and penalties of perJury, that:
O I am an employer providing the following %vorker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Daze)
( ) 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) (Insurancc Company/Policy Number) (Expiration Date)
(Name of Contractor) (In.,�rranc: CompanyPol cy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(at2acft additiarit ibcei ifncc,,cry to nnclude info=6oa pcztaining to all radon)
( ) I am a sole proprietor and have no one working for me.
( I am a home owner performing all the work myself.
lNOTE:please be awuc that whilo homco%vrxn who employ pc=m to do nizinicnAncr,coassucdon ar rzpair work on a dwelling of
not morn than throo unite is which the homoowner reside or oa tbo ground,appurtenant tbercto arc not generally ooandcrcd to bo
employers under the W%+,c`a oompcnsaiica Ad(GL152fz 1(5))�application by a hotmeowncr for a license a permit may evidenoo the
legal etatua of an omployoc undor tho Wockor'a Companslion Act
I understAnd thsi a copy of this atatcmcnt may be forwarded to the Dcpnrtnco2 of Indushi d Aoadzc&Oboe of lusurance for the
coverage verification and that failure to scarce covazgo under soctioa 25A of MOL 152 can lad to tba k4-1h-of criminal penalties
oomistirg of a fine of up to S1,500.00 andlor imprizonnx�of up to one year and civil penalGa in the form of a Stop Work Order and a
fim of 5100.00 a day LpiaA me.
For dcpartnr=Ctal use caly
/? ,�' Permit Number
2v
` Y . ap# �_Lot# _:
`; Si of LioanseclPcrmitxce e
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 columm to be filled in
by the building Uep+xrtment
Required
Existing Proposed By Zoning
Lot size
Frontage o2
y
�7 r
Setbacks - frnnt
- side L: G R: 4�y L: "R: 9' U
- rear 76
Building height 1315,--
Bldg Square footage 0 �a
%Open Space:
(Lot area minus bldg J �/
&paved parki_ngj L'
# of Parking Spaces
# of Loading Docks
Fill:
-(vol-ume-& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowled e.
DATE: APPLICANT's SIGNATURE
NOTE: Is uanoa of a zoning permit does not relieve an ap ioant's burden to comply V#V4 all
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission. Department of Publio Works and other applicable permit granting authorities.
FILE #
, �q
File No. 7 � 1
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL .INFORMATION
1. Name of Applicant: /G r =U / . 14
Address:/-)� Telephone: (S 122
2. Owner of Property:
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: �� �12�n�-a a5�'C'tt
Parcel Id: Zoning Map# Parcel# ;` District(s): J/e
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5, Existing Use of Structure/Property 1�f ( A
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 Permit/Variance/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 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)
Q• FILE # i
Ar 2 4 6998
APPLICANVCON' ACT PERSON:
PROPERTY LOCATION:
MAP PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PER UT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
FPP Paid
Building PerrniLF-ills-d Alit
Fee Paid
J � O
L--� -
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION'
_LZApproved 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 g� Water Availability Sewer Availability
Svc Bd'of Health Well Water Potability-Bd Health
mit from Co ery n on
Signature of Buildin ector Dat
NOTE:Issuance of at 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 Publio Works and other appiionble permit granting authorities.
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