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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.