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36-232 (2) ... � �l • 7t ,J # t n r � ,Ip ` e, +� �y ��, 5.�' • f g� 1. S rib e a 3° "S ���'rf• Rt yp t } ,fix �' '4 ': x p�3 �r '�� �.. "{� '"`�-� F�S d`t �'a `a i[ 'e�'i i a� � -�`t 1 t ✓fie° V t"r,'„�. r :,�• tin 'i � `��h 4.::-� r!' � $�� Y ti r� Fr r ��� � a✓ _ ire s'`✓ �F Y t r k: � � r"� 'f� a +�� +"�t� �.. M1. k �'fr.^ �a Y ,.$ t V ✓, y W , + } VA ye t' fP `' 1» U �' ° k �f Im 1 �+ F1 �� � ''.' ,Y "•z - d - ,jjk 4, ! p.- u : '.1 q si4k• «,,� t ` •, CD CL �CID CD CD CD 0 CD CD CD E3 CD CD CD CD CD CD CD CD CD • i +s. `° 43$ ', � Wad 'c • • d y..�O�tt „d."�t � 9Yr1^;Y• �I171 I'� `;1 s " 2l ro YC AY. a .� > z c � a: 3 a C > -TZ-', pnp o C4 C > o yO Z --1 r Zoning Miscellaneous Additions,Repairs.Alterations,etc. Tel.No 12) >f3 Alterations NORTHAMPTON, MASS. d1,4 `� —7�4 1952 Additions APPLICATION FOR PERMIT TO ALTER Repair a Garage 1. Location /-Z bi 14--pi C, -'f4 �/ v ?i� r�� v v d�l G < 4G Q Lot No. Y T 2. Owner's name '�` �erW��z �Z? �C&l�y Address /2 v•� ^,� Cr �, ���a <z,-���.y 3. Builder's name �! t-= �� �` J �/a� y Address �/S� �bt.4,W 1 r 7�-o"A-v 0/2 A- Mass.Construction Sueervisor'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 certifies that the above statements are true to the best of his, her knowledge and belief. Signature of responsible p icant Remarks OQ Ctt PLO g 199( Grit , nx#f�ttntnn ; � qtr �asaacllnaetfa `DEPARTMENT OF BUII.DWG INSPECTIONS "ter" 212 Main Street a Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT (licenses) 'flee} with a principal place of business/residence at: _7-0-.1 111• ©/66 a(phone#)Lg13 ST6=s�� (Street/city/s(aw2i p) do hereby certify, under the pains and penalties of pedury, 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) am a sole proprietor, general contractor o homeown circle one) and have hired e tractors listed below who have the following or eI's compensation policies: (NAi6e of ontractor) (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) (snack additiornl sheet ifneoenary to include information pertaining ton oo tmcto,$) ( ) I am a sole proprietor and have no one working for me. I am a home owner performing all the work myself. NOTE:please be aware that whilo homaowaers who employ persons to do usaiateaav= construction or repair work on a dwelling of not more than throe snits in which the homeowner naides or an the grounds appurtsnaut thereto are not gaxmily coosidered to be employers under the wsxkees oompaasation Act(GL152 ss 1(5)),application by a homeowair for a liccase or permit may evidence tho legs►statin ofan employer underthe Worlcoes Compemation Act_ I understand dud a,copy of this statement may be forwarded to the Departmcat of Iadushial Accidartd Offioe of I ntewoe for the coverage verification and that failure to sec um cove:rago under section 25A of MGL 152 can lead to the imposition of criminal pennitiea ooasb4ing of a$ne of up to$1,500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Oaks and a file of 5100.00 a day against mo. Signed this_ day of 1�1i4 1995 For dgnrtaimtai use only Permit Number 2 51 Map# Lot# Si of LicenseelPermi ter." i 1�858ACI�IIStII� T DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street ' Municipal Building Northampton, Mass. 01060 HOMEOWNER LICENSE EXEMPTION (Please Print) DATE• t h 7 JOB LOCATION: 7? 3 L22,721" (Ma ) (Parcel) (Subdivision) HOMEOWNER:_ (Name & A-dfdress ) /,= � Z�4�e,y 0 (a��c� (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 4 BUILDING PERMIT # .. L910L Aea V661 WJOj (OL/,6VXMLC)dd `(ULEXMLr)d01'(Oz/,VZXMWMHO '(OZLXMLC)3OO'lUZLXMSWDO-100 (OLhO£)c Ml£)OH(I'(OSLXML£)000`(0SL)(MS000-100 (Ozh L9 X Mz/,6V)dd`(09V X ML/,6V)dOl`(Ot/,0£X ML/`6V)dH`(OZhO£X ML£)0H1`(OL/,0£X M=hVZ)0H4`(OS L X ML£)001`(OS L X M=/,VZ)000`(OS L X MZ 0 00.100 Oy 0£ OZ M r *+>w vitu -t d 6A Gsc o V pav .v s T tl 2 a P�' `w r/ 5 b7 4 / i A (�6r �Jl tivvrF H t c.oN<s ��► rp s G . i MAY 91997 � 3 ? 6 -7-je r 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 cols to be filled in by the Building Department Required Existing Proposed By Zoning Lot size Rc2rS Frontage Setbacks l - side L• R:_I!Z Ly& R: - rear l Building height Bldg Square footage 9 9 j4ZI 3 p %Open Space: (Lot area minus bldg l �� &paved parking) -2 �2 bf -Parking Spaces of Loading Docks Fill: (vol-dme--& location) 13 . Certification: I hereby certify that the information contained herein G is true and accurate to the best of my knowledge. .1 D2'l'E: c/ APPLICANT's SIGNATURE NOTE: Iss anoe of a zoning permit does not relieve an ap lioant` urden to 00 ly mgw'.oll zoning requirements and obtain all required permits from the Board of Health Coinservation Commission. Department of Publio Works and other appliomble permit granting authorities. FILE # 91991 File No. ^, / PERMI T APPLICATION (§10 . 2) PLEASE TYPE OR PRINT �/ALL /INFORMATION 1. Name of Applicant: G r4F4- F f� E �/ Address: /A k/9Mc- 4 Or y (-) / r4-H/J7-d1/ Telephone: L1-3)5k(, —3f>6 2. Owner of Property: 'E S` 6if'4 o L /L� , �/%{ Address:/,), �i rv�Nn Or NO 22-/4�7y& Telephone: ) ,!5-k 6 3 S 6 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): 4. Job Location: Parcel Id: Zoning Map# Parcel# District(s): jiC;/ (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property OR i.t-1 A e 424 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if neces/sary): 1V -2-19f /+-A/ i,Va /-'-vti- /d' 3& ,4� v t- 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 Y 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) FILE # 9 5 ?2 31 �� 43q7 A�PLICAI NVC T'A T PERSON: 1 `s ADDRESS/PRONE: rr. "° tOPERTY LOCATION: MAP PARCEL: o),3,�)- ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE 7.0MNG FORM FILLED OUT (v)t- f 3 Addition to Exisfin2 ✓` 7FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION' Approved as presentedibased 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 mmissio Signature of Building for Date NOTE:Issuance of a 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 applicable permit granting authorities.