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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location /, c S %R r=L/` o f Ys` A it 1 h wiI N � �' C Lot No.
2. Owner's name 71, Al.a s ✓t�- 1%1, /,a , s Address .S J y
3. Builder's name S`A M k Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration :Pri`ie �� /sicr'�' f C-P,e tkes
6. New Porch
7. Is existing building to be demolished?
8. Repair after the fire if
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof
13. Siding house
-J14. Estimated cost:-
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
Signature of responsible appicant
Remarks
' o�stu>•rpTO 4
3 �X1
of 'Nart4ally trill
FOCT 2 9 1919$ Mesaaclluartla
t
D ARTMENT OF BUILDING INSPECTIONS �
INSPECT R rr. ; 2' 2 Main Street ' Municipal Building '
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
DATE: /6L,2 -$/ (Please Print)
JOB LOCATION•
(Map) _(Parcel) (Subdivision)
HOMEOWNER: ZZ o Ll/4 S /19. 1'17,^1 J r .it i s .3
(Name & Address )
Tit /t .-Se 7 •- /� 3`Y
(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 SIGNAE_,,�'
TTJR
BUILDING PERMIT # _.;,`
by`�KwxrpT0 1
t
o, 09 2 9M r laf Nart4alliptall
9 B 1 Mx3sach not US
OEPt
m ORii.r Iii°1 IAIDEiFA T14ENT OP BUIL-DIT(C INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
woRICERtS Co-I�UENSATION INSURA-NCE A , t AVIT
i
I, o
/-1 ��c �f 6 ti I S L j`'l R e M T ?�
(li c;;;nsec/permi ttee}
%vntL a principal place of business/residence at:
- ��K �� l i zl !vim R TAa M4? &I (phoaer�) 5-9Y- -z 9 1
(strr~t/ci ty/stale/a P)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my ,
employees worbdng on this job:
(Lasurance Company) (POLiCy Number) (Expiration Dace)
( ) 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:
(Name of Contnctor) (Exmi ,6oa Datc)
- -(Mine oI Contractor) -- (Ir!Se` nc: Conlor_Il`'/Poh NwnC-F) (E`plf-aeon Datc)
(Name of Contractor) (tnsw-anc:!� Company/PoL-cy Number) (Expiration Date)
(Name of Contractor) (Insurance ComoanylPolicy Number) (Expiration Date)
(attach additicia l shed if nec�to iodu6 infccm.:ica pertaining to all ecatr-C -n)
O I am a sole proprietor and have no one wor4dng for me.
(vj I am a home owner performing all the work myself.
NOTE:please be avnrc that whilo hot=ov.nm wbo cooptoy pertona to do miat • coa5tNctioa cr repair%voric on a dwdliog of
not meav th_n throo units to ts-hveh the homoouvcr r=,4,=or oa the grounras eppur�thac(n arc not gcneczllY eonsidacd to be
employers under tho vmrkce'i ooaV="-lien/tit(GL152,=1(5)),,apptieanon by a homcoa-ncr for a 6ccuse oe Permit may cv;dcocc the
losil rtahra of an omployoc under tho Worlcces Coatpcoa&Gca Act
I undersitnd that a oopy of this MU—cat may bo focvrnrdod to the Dcynrtnxas of Industrial Aecidmb'Oifioo of Imur'°°o for tlm
cov=gc vcrificalion and that fAum to soa=cov-,a under soction 23A of MGL 152 can lid to tho'itnpos—of-kairul pc altic
oomistatg of A fine-of up to S 1,5 oo.00 an&cc is�rnocu of tip W oae ye=r and civil pcmltics is the form of a Stop W orie Order and a '
fins of5100.00 a day Xpinit tna.
. ' Foc dcp+riial tii°ooly -
Pcrmit Number
°Yg tttui of Liccnsc&Permittce
10. Do any signs ebst 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 col=a to be filled in
by the Building Z�epartmeat
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 of Loading Docks
Fill:
(vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
✓DME: /� y'� `APPLICANT's SIGNATUREE�,y,
NOTE: Issuanoe of a zoning permit does not relieve an applioant's burden to oomply witb7a n
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applionble permit granting authorities.
FILE it
Off 29ke
DEPT File N0,0
PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
�,A. Name of Applicant: �o .S /-�._ 1110 1 Ke'e-/S 9 c g J rV
Address: f 1`/ f'A R /( 1 J Telephone: ��y
2. Owner of Property: 3 -'E?
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
�4. Job Location: AcCass S T £L- I c L `I 5
I4-'K N t A N A V L
Parcel Id: Zoning Map# Parcel# .2 3-c-C31-o-11 District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property '�-F H
,r6- Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
EM "V <; /'-2 X ay A L4!A /l G/ykAr.; L
/ j L%A;,C / /? /c,
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-1-1_ 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#BP-1999-0467
APPLICANT/CONTACT PERSON THOMAS MOLITORIS
ADDRESS/PHONE
PROPERTY LOCATION NORTHERN AVE
MAP 25C PARCEL 031 ZONE V)N-
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid ✓
Building Permit Filled out
Fee Paid '
Type of Construction:
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Occupant Statement or License# `�
3 sets of Plans/Plot Plan
T OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
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
r2jaLjLqar d of Well Water Potability Board of Health
Permit from Conservation Commission
Signature of Building O Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission, Department
of public works and other applicable permit granting authorities.
Department: Reference No: BP-1999-0467
...................................
Building, Electrical & Mechanical Permits
............................... .........................................................
Fee Type: Receipt No:
demolition lZEX'-1999-001269
......................................................................................
........ .............................
Paid By.- Paid in Full Om
Tbomas Molitoris Thu Nov 055,1998
.........................................................................................
......................................
Received By: Check No:
Linda Lapointe 394
......................................................................................... ......................................
DEPARTMENT'S COPY Amount'. $10.00
----------- - - ----------
DEIIIARTMF�'NTFILE (7011Y NORTHERN AVE
CITY OF NORTHAMPTON
BUILDING PERMIT
Owner's pulling their own permits or dealing with unregistered contractors for applicable work do
not have access to Guaranty Fund(MGL 142A)
Issued: Permit No: Inspector: Trackiny_No.: Fee:
BP-1999-0467 $10.00
GIS Map Block: Lot: Address: Zonin%!: Use Group: Lot Size:
4418 25C 031 001 NORTHERN AVE URB 5009.4
Contractor: License Type: Insurance:
Homeowner as Contractor
Address: License No.: Insurance No.:
LiLi State: Zip Code: Phone:
Proiect No: Categor
_V of Work: Const. Class: Cost Estimate:
JS-1999-0901 demolition $500.00
Description of Work:
DEMO 12 X 24' GARAGE
GeoTMS@ 1997 Des Lauriers&Associates, Inc. Signature: