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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 1 q Additions
APPLICATION FOR PERMIT TO ALTER Repair
�� x Garage
1. Location
Lot No.
2. Owner's name Sow �� Clr,c�g�,.� G,S Address Sic
3. Builder's name Address
Mass.Construction Supervisor's License 1No. Expiration Date
4. Addition C
5. Alteration C_ sV
M '�lV"1� C� ��:('W G�„� •-yp(� w�.�•w �ZI'�.1t °'�v �`i
6. New Porch
7. Is existing building to be demolished? No
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating
1 l. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost:- Vk
U
The undersigned certifies that the above statements are true to the best of his, her
'Ak C�-S4 knowledge and belief.
-,4TV x N-X So u 1'
S gn ure of responsible appicanl
Remarks
CANE-CENTIMETER GRAPH PAPER
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ONE-CENTIMETER GRAPH PAPER
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
with a principal place of business/residence at:
<r3 s 1.st 21 �A—s,, F 'L--,e Au c�btvl(�hone#) 5 3�7)
(str�t/city/statPJ�p)
do hereby certify, under the pains and penalties of pequry, that:
( ) I am an employer providing the following wor'r_ei's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Daze)
( ) I am a sole proprietor, general contractor r homeowner circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (insurance Company/Policy Number) (Expiration Date)
(Name oam foam f Contractor) (Ins-umcc CompanytTolicy Number) (Expiration Date)
U"'- () �1 11 (og i(o S
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (insurance Company/Policy Number) (Expiration Date)
(attach additioml sboce ifnoccnuy to includo information pertaining to all oocsraeton)
( ) I am a sole proprietor and have no one working for me.
T am a home owner performing all the work myself.
NOTE:please be aware that wbilo homeowncrz who cmplay pazow to do mxintm• cc�amsuucuonor repair work on a dwelling of
not man than thrm units in which the bomoowner reside,or oa the gvunds apprutenwi thereto arc not generally oo=dcrcd to be
employers under the worker's ration Ant(GL152,s 1(5)�application by a homcowncr for a license or permit may evidcme the
Iepl etatua of an amployer under the Woricoes Compensation Art
I undc:tand that a copy of this--rd may bo forwarded to tbo DqQ rt ofL>&utid A=&ri&Offioa of Inauranoo for the
coverage verification and that failure to soatrc covaago under section 25A of MoL 152 can lead to the imposition of criminal penalties
comisIing of a fine of up to S 1,500.00 mtdlor of up to ooc Year and civil pcmltia io the form of a Stop Work Ordcr and a
fins of 5100.00 a day against me
1
Signed p� day of V 199 7 Far d�ara al ub only
Permit Number
Maps{ Lot#
Si of LiccnscelPermittee
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d+nADDAC��118lt�D
m DEPARTMENT OF BUILDING INSPECTIONS -
NSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass, 01060 M `
HOMEOWNER LICENSE EXEMPTION
\ (Please Print)
DATE: J��� Z.l,V �1 et o1�
JOB LOCATION: 17e ' f
(Man) (Parcel) ( Subdivision)
HOMEOWNER: S l J � 1 A 4 i� �,c q v t c�tv L
(Name Address )
C S$io3��� S�G�Io 17a X 3Nl
( 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 SIGNATURE
BUILDING PERMIT #
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 w2mom to be filled in
by the amilding Department
Required
Existing Proposed By Zoning
Lot size 71
Frontage „ -a 93� -3 '
Setbacks /
- side L:�` R: k� L: 5 R: -7ol
- rear `A b »
Building height 'IS I
Bldg Square footage I.oo S',k4- (ay S�-4
%Open Space:
(Lot area minus bldg y�#d9 '� °10
' &paved parking)
f -Parking Spaces
# of Loading Docks
Fill:
{volilime--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledg
_1 /
DME: y Z�,, ri APPLICANT's SIGNATURE
NOTE: Issuanoa of a zoning permit does not relieve an a p foanYs burden to comply wittl,.rpU-
zoning requirements and obtain all required permits fro he Board of Health, Conservation
Commission, Department of Publio Works and other applicable permit granting authorities.
FILE if
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: t.'j f''�S
Address: )1-f C�N-e re, t-C _Telephone: S I
2. Owner of Property:
Address: Telephone:
3. Status of Applicant: _Owner Contract Purchaser Lessee
Other(explain): pJ4
4. Job Location:
Parcel Id: Zoning Map# Parcel# District(s): .� ��
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)`?
S. Existing Use of Structure/P rope rtyli=
6. Descrilon of Proposed Use/Work/Pr 'ect/Occupation: (Use additio l sheets if necessary):
C-1.-.lti. AL-,U,
AQ
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 D9cument#
9. Does the site contain a brook, body of water or wetlands? NO t 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)
fir, 4 � �U
FILE
JUN 2 6 1997
AP,PLICANTlCONTACT PERSON:
F c�
A ll �S /TAONE
PROPERTY LOCATION:
MAP "z� PARCEL: ZONE
THIS SECTION FOR_�OFFICIAL USE ONLY:
PERNIIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT Le�_
Fee pnod
o �—
New Cnngtriirtin
Addition to Rxisting nim-_�,,
ArreggnryStruettire
Irlilded-
If—e-
THE OLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
Approved as presentedfbased 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
!Pe it from Conse Comm' Sion
Signature of Building lifspector Date
NOTE: issuanoe of a zoning permit does not relieve an applioant's burden to oomply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authoritlas.
City of Northampton REQUnRXD INSPECTIONS
s
e 1. Footings and Wpalls
BUILDINGDEPARTMENT 2. Structural Com onents in Place*
3. Complete Building*
Office of the Building Inspector
No. 610
Zoning Form No. 962454 Date 7/1/97 Fee$40.00 Check# 1204
Page, 17C Parcel 41 ,Zone URB Section 127 ❑ Yes 0 No
BUI]LDINGPERMII
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT ,Ion/Christine Sass before Building Inspections
remove dining room wall,bathroom in 1st floor closet Inspection on Site—Foundations
has permission to & s, x- Q- ed-
situated.on 63 Sheffield Lane - Florence Inspection of Plumbing—Rough
provided that the person accepting this permit shall in every respect Inspection of Plumbing—Finish
conform to the terms of the application on file in this office, and to the Gas Inspection
provisions of the Statutes and the Ordinances relating to the Construction, Inspection of Wiring—Rough
Maintenance and Inspection of Buildings in the City of Northampton.
Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring—Finish
of this permit.Expires six months from date of issuance,if not started. Building Inspection—Rough
Note:A certificate of occupancy will be issued by this office upon return Insulation Inspection
of this card signed by the Plumbing,Wiring and Building Inspectors.
Building Inspection—Finish
Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON PREMISES
Certificate of Occupancy
Bu' Z g nspector
City of Northampton REQUIRED INSPECTIONS
! 1. Footings and Walls
BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
No. 610 Office of the Building Inspector
Zoning Form No. 962454 Date 7/1/97 Fee$40.00 Check# 1204
Page, 17C parcel 41 ,Zone URB Section 127 ❑ Yes 0 No
BUI]LDING PERM I I
*Plumbing and Electrical Inspections required
THIS CERTIFIES THAT ,Ion/Christine Sass before Building Inspections
remove dining room wall,bathroom in 1st floor closet
has permission to & a, X 2, shed Inspection on Site—Foundations CQUIsituated on 63 Sheffield Lane - Florence Inspection of Plumbing—Rough f,q 7
provided that the person accepting this permit shall in every respect Inspection of Plumbing—Finish _ d
conform to the terms of the application on file in this office, and to the Gas Inspection
provisions of the Statutes and the Ordinances relating to the Construction, Inspection of Wiring—Rough
Maintenance and Inspection of Buildings in the City of Northampton. /
Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring—Finish Ir
of this permit.Expires six months from date of issuance,if not started. Building Inspection—Rough
Note:A certificate of occupancy will be issued by this office upon return Insulation Inspection
of this card signed by the Plumbing,Wiring and Building Inspectors.
Building Inspection—Finish Q`L, LE2?" ✓
Smoke Deteci.ors(Fire Department)
Other
THIS CARD MUST DISPLA CONSPICUOUS PLACE ON PREMISES
Certificate of Occupancy
Bu' g spector