25A-144 (4) - >
v
Oil Z� a
— C
T � Z
Ile z � / m
_ Zoning
Miscellaneous Additions,Repairs,Alterations,etc. el.No y c Alterations
a NORTHAMPTON, MASS. l �Y) 19 Additions
APPLICATION FOR PERMIT TO ALTER' Repair
Garage
1. Location �_ S Lot No.
2. Owner's name C - �7 Address 5
3. Builder's name r Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
-> ,�1✓� �'�- � )
6. New Porch
7. Is existing building to be demolished? /V O
8. Repair after the fire
9. Garage 4 No.of cars Size
0. Method of heating ``
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated Cost- ' 506
The undersigned certifies that the above statements are true to the best of his, her
know)edj a and belief.
r✓
Signature of responsible app lcanl
,l
Remarks
Grit: of Naz llam ton
DEPARTMENT OF BUILDING INSPECTION
INSPECTOR 212 Afriin Street ' Municipal Building
Northampton, 1V SS. 01060
HOMEOWNER LICEN E EXEMPTIO
�d1/` (Please P int)
DATE.
JOB LOCATION:
N (pAp) ( Parcel ) /d, �7 ( s bdivisio )
HOMEOWNER: •T .
Name � ��res�� ���
( H me Phone ) (Work Phone )
The current exemption for "home wners" was extended to include
Owner-occupied Dwellings of one ( 1 )or two (2) famil ies and to allow such
homeowner to engage an individual for hire who) does not possess a
license , provided that the owner actE as su erv' sor • CMR780 Section 109. 1 .
DEFINITION OF HOMEOWNER: Perso ( s ) who owi a parcel of land on
which he/she resides or intends to ieside , on which there is , or is
intended to be , a one or two famill dwelling, attached or detached
structures accessory to such use and/or farm str iQtures . A person who
constructs more than one home in h two-year period shall not be
considered a homeowner . Such "homeow er" shall submit to the Building
Official, on a form acceptable to the Building Official , that he/she
shall be responsible for all such w rk performed under the building
permit .
As acting Construction Su ervis r your presence on the job site
will be required from time to time, during and pon completion of the
work for which this permit is issued
Also be advised that with ref rence to Thapter 152 (Workers '
Compensation) and Chapter 153 (Liability of Empl yers to Employees for
injuries not resulting in Death) of the Massa husetts General Laws
Annotated, you may be liable for person( s ) you hire to perform work for
you under this permit .
The undersigned "homeowner" cer ifies and assumes responsibility
for compliance with the State Bui ding Code , City of Northampton
Ordinances , State and Local Zoning aws , and State of Massachusetts
General Laws Annotated .
HOMEOWNER SIGNATURE
BUILDING PERMIT
a
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.
Thin cols to be filled in
by the Bni.lding Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks -frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
' &paved parking)
;# _pf -Parking Spaces
of Loading Docks
Fill:
4 volume--& location)
13 . Certification: I hereby certify that the information contained herein
_ is true and accurate to the best of my knowledge.
DATE:
7,-5/1��Lq /� APPLICANT'S SIGNATURE � � L/,
}" NOTE: 1 unnoa of a zoning permit does not reliev applioanre burden to oomply withr„eli
zoning requiramants and obtain all required per from the Board of Health, Conservation
Commission, Department of Publio Works and other applicable permit granting authorities::.
'`, FILE # 7C,
File
V 1
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR T ALL INFORMATION
1. Name of Applicant:
Address: l Telephone:
2. Owner of Property: � =
Address: Teleph ne:
3. Status of Applicant: Owner Con ract Purchaser Lessee
Other�(expplllain):
4. Job Location: �-' :i+ Y �
Parcel Id: Zoning Map# Parcel istrict(s):�� � Xf-
(TO BE FILLED IN BY 1 HE BUILDING DIE ARTMENT)
5. Existing Use of Structure/Property I
6. Description of Proposed Use/Work/Project/Occu lion: (Use additio al sheets if necessary):
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checkin I with the Building Dept or Planning Department Files.
8. Has a Special Permit/Variance/Finding ever be n issued for/on the s e
NO DON'T KNO0,; YES IF YES,date issued:
IF YES: Was the permit recorded at the Regis of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Pag and/or Document#
9. Does the site contain a brook, body of water or WE ands? NO DON'T KNOW YES
IF YES, has a permit been or need to be obtained from the Conserva 'on Commission?
Needs to be obtained Obtain,-d ate issued:
(FORM CONTI UES ON OTHER IDE)
FILE #
r ,
MAi L 4
APPLICANT/CONTACT PERSON:
ADDRESS/PHONE:
PROPERTY LOC TION: A0
MAP PARCEL: ZONE �2
THIS SECTION F R-OFFICIAL SE ONLY:
PERMIT APPIL ICATION CHE CKLIST
ENCLOSED REQUIRED DATE
ZONING F()RM IMLED OUT
Rnilding Pp. .. it Filled pitt
4errindelin2 Interior
T/,,.�LOWING ACTION HAS BEEN T NON THIS APPLICATION'
Approved as presented/based on information presented
Denied as presented:
Special Permit and/or Site Plan Required nder:§
PLANNING BOARD ZONING BOA
Received&Recorded at Registr of Deeds Proof closed
Finding Required under:§ /ZONING BO OF APPEALS
Received&Recorded at Regist of Deeds Proof nclosed
Variance Required under: § _w/ZONING BOA RD OF APPEALS
Received&Recorded atRegistrvof Deeds Proof E closed
Other Permits Required:
Curb Cut from DPW -Water Availability Sewer Availability
Septic Approval-Bd of Health We U Water Potability Bid Health
Pe 't from Conservati ommissi
Signature of Building OM-or 6ate
NOTE: Issuanoe of at zoning permit does not relieve an app idant'a burden to oomply with all
zoning requirements and obtain ail requir d permits fro the Board of Health, Conservati4,
Commisslon, Department of Publio Works Eand other appl oable permit granting authoritlev,
C
' �•w•�r•
0' Z' 0, ° o 14. ° ~off
0
o CL o
0
� a0 = ~• 9
O
li i' O '"' is' K O 2�
A r°i� f9 `.Y 110
M �� 5 Ol 1j N
N
CD b g�g ° N( D
o
rt
O (D n o
�--i Q sv co ° n n Ir•
� � A C=
oa 0 (D
� y
�
d 5 � o �� < � c� Z
y b �° o d O
� a�
C
rt
0
0
0O O
C-11 0 5 5 5
CD
ot
> q 9=. 0 = � y
Lo
(�
C1j aQ 5 UQ °� o 0 0
5 0 0 CA N N
'z7 � \
CD a
o G7 c v C 7
O 5 O 04 Q S UrQ aQ ° �• to ►rf
5 ►rJ �1 `� p� ❑ o chi °,
o o o y o
cD y
' O• �° O � �° ! v' O OFD
c
CIQ
y
ll, ° to 0
Z
ZZ
A
CD
� rrc b o
� C, o
CD N
= °' m
cr 10 In
cro m W
rr
n cro n `� V ` 1
CJ c = 2. 5 '"tom
' n
qq
\ p m ~ �' ell,
g.qq D
s (D O p P < �y
eOn < R 4 W O
� � o
o � �
� s ~
CD w
cD C -• `d R. K. C n
tv
ITI
` v „S�' � s1 0 ►d � CNTt
�• a C4
qq
qq
t 11J
r ' y
, ; z �