The URL can be used to link to this page

03-010 (6) > o -e a Z G R � z LO S c ., Z cv > Z rn p I A Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. -Q -3 Alterations NORTHAMPTON, MASS. 1 g Additions APPLICa ATION FOR PERMIT TO ALTER Repair fir— Garage 1. Location 1 C � /"'/FA��RJ ` /�— Lot No. 2. Owner's name �t-`� ROj�f Address -5AMCf" 3. Builder's name Address Mass.Construction Supervisor's License No. Expiration Date 4. Addition 5. Alteration WJs ACWCZ S-1 SAN M466, 659c —mn l / ,J /// 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. Type of roof 13. Siding house 14. Estimated cost- The undersigned certifies that the above statements are true to the best of his, her knowledge and belief. Signature of responsible app,icant Remarks 0 4T 11AM p�O �1:s>SArhtr$�tt>s m DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT L (licensee/permittee) with a principal place of business/residence at: (phoney#) (Strcet/ci ty/stal-elzi 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 working on this job: (Insurance Company) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, general contractor o(homeowner - cle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Poky Number) (Expiration Date) (Name of Contractor) (Insurance Company/PoGcy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional shout ifncc s to include informition pertaiaing to all oorrtractors) ( ) I am a sole proprietor and have no one working for me. am a home owner performing all the work myself. NOTE:please be aware that while hotneowo=who employ persoas to do msiat.,mn e construction or repair work on a dvecliing of not more than three units is which the lwmaowner resides or oa the grvan6 appurtenant thereto an not gaxrclly oo=dacd to be employers under the vmrica's lion Act(GL 152,ss 1(5)},application by a homeowner for a license or pan-a may evidence the legal stahu of an employer under the Worleeez ConVemaiion AcL I undm-xt=d that a oopy of this ctatomeat may be forwarded to the Department of Indrsstrial A«adent- ofrroo of Imuranoo for tho coveage verifir aiioa and that failure to se==coverage under section 25A of MGL 152 can lead to the inxpenition of crim penal tics oomisting of a fine of up to 51,500.00 and/or imgrisoumcnt of up to one year and civil penalties in the form of a stop Work order and a fine of 5100.00 a day sgni>bA tna --1[N D-y- Signed this Z,5_day of .S6r 1997 For dcpsrtintow—only Permit Number 1, Map# Lot# Signature of Liccnser/Permittee 0 a a (rz of 'Nozf1ja1>pfoil r P �A14$C�j❑&f��E SP 2 5 d DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 HOMEOWNER LICENSE EXEMPTION q ? q;y_ ( Please Print ) DATE: 1 JOB LOCATION: (Map) ( Parcel ) ( subdivision ) HOMEOWNER: SRX6 O / ( Name & Ad�ess ) DZ� ( Home Phone ) (Work Phone) The current exemption for "homeowners" was extended to include Owner-occupied Dwellings of one ( 1 )or t��,,n (2) fami 1 ies and to allow such homeowner to engage an individual for hire who does riot 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 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 colnmm to be filled in by th- Baild=q 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 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. D?II"E: APPLICANT's SIGNATU NOTE: Issuanoe of a zoning permit does not relieve pplioanra burden to oomply w(tlp,. ll- zoning requirements and obtain all required permits from the Board of Health, Conservation Commisslon, Department of Pubiio Works and other applionble permit granting authorities. FILE # SEP 2 5 Fi l e No.. i ZONING PERMIT APPLICATION (§10 . 2 PLEAS l E TYPE. OR PRINT ALL INFORMATION 1. Name of Applicant: S-K- nF OTT/ Address: � �S��Z �5I'� � Telephone: 2. Owner of Property: ��14 Address: Telephone: 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): 4. Job Location: 5:35- CLES Parcel Id: Zoning Map# Parcel# District(s): �/L� (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): 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/Vadance/Finding ever been issued for/on the site? NO DON'T KNOW YES IF YES,date issued: IF YES: Was the permit recorded at thhebbb rb 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 #_ 962824 AAN41CONTACT PERSON: ADDRESS/PHONE: PROPERTY LOCATION: MAP 13 PARCEL: ZONE THIS SECTION FOR-OFFICIAL USE ONLY: PERWr APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM Eff J ED MIT Fee Pnid Buildin2 Permit Filled nilt New Cnnqtrjirtinn Additinn to Existing D) n-, Tnrhided- THE, LLOWING 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 Appal-Bd of Health Well Water Potability-Bd Health !Permit from Conservatio Itommission — Signature oMrrcrng r Ifate NOTE: Issuanoe of a zoning permit does not relieve an appiioant's burden to Comply 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 authorltles. A. , ("Ity of Northampton REQUIRED INSPECTIONS 1. Footings and Walls BUH-jDING DEPARTMENT 2. Structural Components in Place* 3. Complete Building* Office of the Building Inspector NO. 915 Dane 9/25/97 Fee$40.00 Check# 1339 Zoning Form No. 962824 Page, 3 Parcel 10 ,Zone RR/WSP Section 127 ❑ Yes ® No BILJH-JDING PER.NITI *Plumbing and Electrical Inspections required THIS CERTIFIES THAT Bruce Roth before Building Inspections has permission to replace sill & framing on back north side of house Inspection on Site—Foundations situated on 565 Coles Meadow Rd 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 rioted is an immediate revocation Inspi-ction of Wiring—Finish of this permit.Expires six months front 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 (tx_ I0-15 `77-4-V Smoke Detectors(Fire Department) �,..Other THIS CARD MUST BE DISPLA IN CONSPICUOUS P C ISES Certificate of Occupancy Building Inspector