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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. �� 'J �J Alterations Jed<
NORTHAMPTON, MASS. d 19 Additions
1
APPLICa ATION FOR PERMIT TO ALTER Repair
IJ /� ' Garage
1. Location 3f' t t'�kLV� �'1` ellam jj Lot No.
2. Owner's name h�1 e'VAAlH Address 30 f t��,�,, 4-yenV
3. Builder's name "64 !:�)6+ 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 0 g� X
12. Type of roof Ski�` 1i'S& t' p
13. Siding house ejV'A&11,V A /A2.t� 0ltA4/
14. Estimated cost:-,,j
The undersigned certifies that the above statements are true to the best of his, her
knowledge lief.
Signature esponsib(e appicane
r
Remarks
MAY 5 '998
IUT OF ;y !�;
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„ MAY
19%
DEPARTMENT OF BUILDING INSPECTIONS
,� 212 Main Street ' Municipal Building
INSPECTO `ar^ f' Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
S ( Please Print)
DATE: D y(
JOB LOCATION• 3c`?' ' [tO�4a i-k
/� , (M p) (Pa,rrpel. (Subd ' v' ion)
HOMEOWNER:_C'��� �dI RV�I 3! �'1�'1„ �r� 4yeni t /Vtt�l��am
(Name & Address )
e 5T 7-Y£yYf� SY6 Y Yl
( 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. a "
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 .
1
The undersigned "homeowner" certifies and assumes responsibility
for compliance with the State Building Code, City of Northampton
Ordinances , State and Local Zoning Laws, a State of Massachusetts
General Laws Annotated.
HOMEOWNER SIGNATURE '�
BUILDING PERMIT #
NAAlP
04 PTO r�
a SAY 5 ,1998
�=ssxclTnsctts
m ) DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street Municipal Building
f =
Northampton, Mass. 01060 '
WORKER'S COMPENSATION INSURANCE AFFEDAVIT
(liceuseolpel-mittee) -
with a principal place of bmmi ess/residence at:
(phone#)
(st1R—t/city/sta tdzi p)
do hereby certify, under the pains and penalties of pegJury, that:
( } I am an employer providing the following worker's compensation coverage for my
employees working on this job:
an-surance Company) (Policy Number) (Expiration Date)
( } I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following workers compensation policies:
(Name of Contractor) (Insuranc Comparry/Poticy Number) (Expiration Date)
(Name of Contractor) Qnsuranc�- Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurances Compauy/Po(icy Number) (E.xpLmtioa Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(suaeh additioaxl slx,ct ifncccmtuy to nwju6c inf0cmitica pertaining to a OoGdradots)
( ) I am a sole proprietor and have no one working for me.
AA I am a home owner performing all the work myself.
NOTE;Plcaac be awam tbst whilo homoo mcn who cinplay perrom to do j,.r �coat v oa or repair work on■dwdliag of
not mono than thcoo units in which the bon3oowncr r,=dcs or oa th-o goon is apputteaeai thcr t arc oot generally ooasidcrcvi to be
cniploy<ra under the wnr*.a`s compcasalion Act(GL152,a 1(5))�applir oa by a homeowner for a!!"case a permit may cvidcacc the
]"gal ttatuo of an omployer under tho Wort &Comp Ltioa Act
I understand that a copy of this c2atcmerrt may bo focwardod to the Department of Indzr-sf d A=dd Offioo of Imurwoo for tho
covcraga vaificalioo and that failure to acatre covcrr-V undcr soetioa 23A of MOL 152 can.kad to tbd impoMian of"-!mina!Petra
oomit ng of a fine'of up to S1,500.00 anNor impris�of up to om year and ava pcmltia in the form of a Stop W orlt Order and a
find of 5100.00 a day agpiwl mo
�
For dq rft =W use y
Pcrmit Number
;•... tgareafLi 'eemittce Map'___Lot#h
--- -
-NOTE-
THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT
CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED.
BUILDING LOCATION ACCURACY IS NOT GUARANTEED
MAY 5 19% x
l L
-s rITT 01
G
RE
TO: FLORENCE SAVINGS BANK &
FIRST AMERICAN TITLE INSURANCE COMPANY
TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF
I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES,
EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
COMMUNITY #
250167 —NOTE—
SURVEYOR: �• J- THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONSTITUTE A PROPERTY SURVEY
�Ro OF S —MORTGAGE LOAN INSPECTION PLAT—
NORTHAMPTON, MASSACHUSETTS
RANDALL PREPARED FOR
°v IZ. w GLENN R. & JACKLYN M. CONNLY
#35032 SCALE: I "=20 ' JANUARY 22 , 1998
�9NO SURV HAROLD L. EATON AND ASSOCIATES, INC.
REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET — HADLEY — MASSACHUSETTS
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 _ NO4-
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
Thin Col.== to be filled in
by the Building Department
Required 1
Existing Proposed By Zoning
Lot size -- j�+U t>)no
Frontage (e
Setbacks d
- side L: R: _ L: R: �r
�J
- rear J::Z' / t f
Building height
Bldg Square footage _ /L-)Jr j
%Open Space:
(Lot area minus bldg _
&p?(red Fay 1Li ) 3� 5- � (] 4J 1.�
# of Parking spaces
# fof Loading Docks
Fill:
-(volume -& location)
13 . Certification: I hereby certify that the information contained herein
G is true an accurate to the best of my knowle e„
DATE: APPLICANT's SIGNATURE `
NOTE: lnauanoe cf a zoning permit does not relieve an applioants burden to pty with-oll
zoning requirements and obtain all required permits from the Board of Heal onservotion
Commisslon. Department of Publio Works and other applionble permit granting muthorities.
FILE #
1
MAY 51998
File No. 9& 3
DEPT QF;>!.11 tt "PECTIO 1�
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: 30 4114U IF vl'en v`e Telephone:
2. Owner of Property: 'k &
Address: f"r y�oY>if►��� tie Telephone: 5�-1 `!Ll ycq
3. Status of Applicant: ,Owner Contract Purchaser Lessee
Other(explain):
4- Job Location: ie 0fli�/�ar-J �
Parcel Id: Zoning Map#_(D� _/)- Parcel# �? District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property • 4 f✓l,10 h)Me
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
- - belt deel� l� a
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 X DON'T KNC!^: 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? NOA— 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)
MAY 5 LOM
4.
DEPT �P-LICANTICON ACT PERSON:
T E
n
PROPERTY LOCATION:
MAP a25-H PARCEL: ZONE u
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Bllildin2 Permit Filled mit
— Fee Paid
._--�
dU
THUOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
Approved as presentedfbased on information presented
I c T" — JC L K. dpi i'j nv�
Denied as presented: Ctow{C 0r exr.-4 ,N{„,." V,r ;,,,-�
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
• c
Well Water Potability-Bd Health
Permit from Conservatio Commission
s`�
Signature of uilding for Date
NOTE:lssunnoe of a zoning permit does not relieve an appiionnt'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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