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25A-131 (10) > V5 M > C-, LAJ Z C� A; M CD;r Cn Z > Z Ca C:) > Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 0 1 Alterations NORTHAMPTON, MASS. 10 - 2 —1923 Additions APPLICATION FOR PERMIT TO ALTER Repair a Garage 1. Location Lot No. 2. Owners name KA i f+6V Lz Address Iq y flU Lfij Lk C— , A09.t#-A-11k P?v 3. Builder's name S HaLbofJ �C-E TP-0 tA 10 In i4 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 12. Typeofroof -S79-if), euR&J 01-YwO01- ADvt- 6Ar2-At6E- /Zrj6F 13. Siding house 14. Estimated cost- -5-5-OZ) The undersigned certifies that the above statements are true to the best of his, her knowledge and belief. J �ignature of rksponsible appicant Remarks- 1 oalilc..3c.. "`-m- O O OCT 31997 it� at Naztllttntptuli 9 6 lassachnstIts DEPT Of BtifLDg4G p&EC TIM'S NORTH "� TDN,MA Oluep ENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT (]icLnser�permittcc) with a principal place of busi-ness/residence at: S-1 �Ay _A-c)G►i (.e_L /UD/ZTfFA*vt PTyA_J (phone#) (str=Uci ty/stately p) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following workers compensation coverage for my employees working on this job: (Insurance Company) (Policy Number) (Fxpiration Date) ( ) 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: (Na-me of Contractor) (Insurance Comparry/Policy Number) (Expiration Date) (Name of Contractor) (Insurance CompanyiPolicy Number) (Expiration Date) (Name of Contractor) JrL>'llfanc_- Company/Tolicy Number) (Expiration Date) (Name of Contractor) (Insurance Company/policy Number) (Expiration Date) (attadl additional sheet Fnaccxssry to inc}ucle infOMU600 pertaining to all cor actors) ( ) 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 wbilo hcmcowocra who employ pczsom to do maintenance,mnsuuctioa or repair work on a dwelling of not moeo thin tbroe units in which the honx>o-ner resides or on the g ouad3 appurtenant tberdo are not gwervlly ooesidered to be employers under the workt"s O=Tcmaticn Act(GL 152,ss 1(5)),application by a homeowner for a license or perwit may evidence the legal atatuo of an omployoe under tho Workeez Compemation Act I unaersuad taut a copy of this rtatcmmt aaay bo forwnrdod to tho DcV>rtmcnt of rodristrW Ar6&.&Offioc of Irrnuance for the coverage verification and that failure to scatre oovcrago under section 25A of MOL 152 can lead to tbo imposition of Criminal penalriea comistiug of a f oc of up to S 1,500.00 and/or imprisonnxrtt of up to one)Tar and civil penalties is the form of a Stop Work order and a fine 0(5 100.00 a day agsinst me. Signed this _____day of_ oc C � 1991 FordgWtW'=W use only /U Permit Number Nbp# Lot# Signature of Liccnseckcrtru cc T tIAM p 0�' TO OCT 31997 rz �frrz-fl7�»> fa�l DEPT OF 8t11LDING INSPErTIONS �nA54ACI�IIHCIl6 _, NORTHAMPTON MA 0106 TMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Strect ' Municipal Building ' Northampton, Mass. 01060 HOMEOWNER LICENSE EXEMPTION ( Please Print ) DATE: 0/21 �j � JOB LOCATION (Map) ( Parcel ) ( Subdivision) HOMEOWNER: A)A0cY T rv`i J4c_y c- s-( A-Y Auetiuc: Non i,/4#Nmp/v� (Name & Address ) Sks' ( Home Phone ) (Work Phone ) The current exemption for "homeowners" was extended to include Owner-occupied Dwellings of one ( 1 )or t�•m (2) fami 1 ies 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 I ` BUILDING PERMIT # 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 C01— to be filled in by the Banding Department Required Existing Proposed By Zoning Lot size Frontage Setbacks - side L: R: L: R: - rear Building height Bldg Square footage %Open Space: (Lot area minus bldg &paved parking) # of Parking spaces f fof Loading Docks Fill: 4 vol-ume--& location) 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. _1 DATE: !D�Z/p�— APPLICANT's SIGNATURE T , NOTE: lasuanoe zoning permit does not relieve anTappiloanifte bur4den to oomply wItF�1,.�p11 zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Department of Publio Works and other applioable permit granting authorities. FILE # 9 OCT 3 �,QFile No. DEPT Of f3UlLDlNG INSPECTIONS a NORTHAMPTON MR 01060 ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: DU AV r Y 1 k i ff L G Address: D A Y AL)o— J tee✓ Telephone: 6-8S'-90 I 2. Owner of Property: ,5 /4- M Fl - Address: Telephone: 3. Status of Applicant: Owner X Contract Purchaser Lessee Other(explain): 4. Job Location: GzL „ Z - Parcel Id: Zoning Map#� Parcel# 3 District(s): (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property laz - 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): STAiP RovV., ki 6-V.J PL><wan*b, ShI/NG L e=' /toad 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) FILE # 9&2552 U ou 31997 1 ACT PERSON:_//C�/dZ-4-�� �1�2PP.[tC N PROPERTY LOCATION: MAP PARCEL: ZONE��<2 THIS SECTION FOR-OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZQNTXC�FORM VELTED OUT Fep Paid /l"&s - ✓ S:�Dcrupant .qtatprnpnt or License 4 i THE FALLOWING 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 Health Well Water Potability-Bd Health _Permit from Conservatio mmissio Signature of Building or D to NOTE: kmuanoe of a zoning permit does not relieve an applicant's 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 applicable permit granting authorities.