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�t Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel. Alterations
NORTHAMPTON, MASS. (� 19 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location ::�6 Lot No.
2. Owners name f2gocc%, r wg—e )(�,tJ zNz Address S-6 5 c y,,�3 L"1 '�`�(J 0
3. Builder's name Address
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. Type of roof
13. Siding house
14. Estimatedcost:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge jpd/belief.
Signature of responsible app,icant
Remarks
+�pQ-�HAINPTO�
�� �Insspcliosette
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DEPARTMENT OF BUILDIT G INSPECTIONS
g 1995 -
INSPECTOR 2l2 Main Street ' Municipal Building ' "
Northampton, Mass. 01060
eJ
HOMEOWNER LICENSE EXEMPTION
��� �� (Please Print)
DATE: i
JOB LOCATION:
(map) (Pars_el) ( Subdivision)
HOMEOWNER: - /<("A //--/
(Name & Address) ,
(Home Phone) (Work Phone)
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings_ of one Mor 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 #
�=o O Rg. Crxt� of 'Naz# ailtpton
• JUN 9 11t 998
3 6 �asaxchnsctta
Of SUf! DEPA.ItTMENT OP BUILWNG INSPECTIONS
212°main Street ' Municipal Building 'a
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(h=-1trJM-Daittee)
with a principal place of business/residence at:
CC
(sti-eet/ci ty/521da p)
do hereby certify, under the pains and penalties of penury, that.
( ) I am an employer providing the following workers compensation coverage for my
employees working on this job.
(Insuranee Company) (Policy Number) (Expiration Date)
(tam a sole proprietor, general contractor homeown 0(circle one) and have hired
the contractors listed below who leave the folio ' er s compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contra(:tor) G surance Company/Poky Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Pahcy Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date)
(attach additiocal sheet ifnteeisary to inchj6c inform ,t pertaining to nll coatracion)
( ) I 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 homcowmcn who employ pasom to do maaftcauioc,omstudion cr repair work m a dwelling of
not morn than throe units in which the bomoownc rciidcn or on the grounds apputtcnr nt thereto arc Dot gcoa ily ooasidacd to be
employers 11Ddef the worker`s coaVcnsafioa Act(GLt52,s3 1(5)),application by n homcow=for a Uccwc or pcatnd may evidcncc the
Iegal rtxtua of an c=ployoe under tile Workoes Compensation Act
I underaiaad tlut a copy of thu a fecal may be fbrwnrdnd to tho Dtpartmco2 of Inds d Ar6&0&OfS of Inw+sncn for the
covaxge vai&calion and that failure to goa ODVtr&o trier socdon 25A of MOL 152 can Icad to tbo imposdron of Q'min.S l penalties
ooazisem of a fmc of up to S 1,500.00 andycr impmoumcat of up to one year sad civil pan ltics in the form Of n Stop Work Ordcr and a
find of Sloo.00 a day agnima me.
Signed this _day of �l���l-% 1991 For dgtttnc"usooalY
Permit Number
Map# Lot#
Si of Liven�eelPerm�
JUN '
x
i s W,,�6
4L
oll
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 propeW YES __ NO_JZ
IF YES,describe size,type and location:
11 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LA K OF INFORMATION.
This colum to be filled in
- by the Build,iag Department
Required 1
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L: R: L: R:
- rear A-
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&p_aved parking)
# of `Parking spaces
# of Loading Docks
Fill:
A volume-4 location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge. ell
DATE: �� _ APPLICANT's SIGNATURE
NOTE: lssdano4 of a zoning permit does not relieve pplicant's burden to oomply Wit"-pii
zoning requirements and obtain all required permits from the Board of Health. Conservt2tion
Commisslon. Department of Publio Works and other applicable permit granting authorities.
FILE #
9
File No.
<.� ► z CeING PERMIT APPLICATION (§10 . 2
m PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: ��Z Yi�t"� �a riY
Address:_55f COLS Nl01, W I,/V /R0. Telephone:
2. Owner of Property:
Address:-5L- 5 (—n),ES Telephone: 5�,S 7 C'OZ-3
3. Status of Applicant: Owner _Contract Purchaser Lessee
Other(explain): ` y
4. Job Location: °oS_ j�(� kd�A ')W R-o
Parcel Id: Zoning Map# Parcel# 10 District(s): C_ P—T
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
F ,.�
6. Description of Proposed UseNVork/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.
S. 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)
}
Y flJ
.1UN 2 2 ;998
I
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w
tT
y
t ; FILE # � �
JUN 91998
APPLICANTfCONTACT PERSON:
t t1F�iiDiD�tES�/P�ON`E•
PROPERTY LOCATION: 4
MAP PARCEL: /Gs ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERK UT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM MLEDOITT
Fee Paid
Rnildin2 Permit Eilled alit
Q_ R�wnddi
Addition to Existing
' r
Acre-s,nry Strurture
/Pint Plan
TliE ,LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION-
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:
{ 4 .,Curb Cut from DPW Water Availability Sewer Availability
^$eptic Approval Bd of Health Well Water Potability-Bd Health
it f CoWry _ C [n is ' n �
Signature of Buildin ector Da e
NOTE:Issuanoe of a zoning permit does not relieve an applioant's burden to comply with ali
zoning requirements and obtain eail required permits from the Board of Health, Conservation
Commission, Department of Pubiio Works and other applioabie permit granting authorities.
oa� �"• City of Northampton REQUIRED PECTIONS
INS
e 1. Footings and Walls
BUILDINGDEPARTMENT 2. Structural Components in Place*
3. Complete Building*
No. 1732 Office of the Building Inspector
Zoning Form No. 963642 Date 6/24/98 Fee $40.00 Check# 1565
Page, 3 Parcel 10 ,Zone RRIWSP Section 127 ❑ Yes Q No
B LTILij G
lr'%�IN PERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Bruce Roth before Building Inspections
has permission to remodel interior bed & bath Inspection on Site—Foundations
situated on 565 Coles Meadow Road Inspection of Plumbing—Rough
provided that the person accepting this pen-nit 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
** Install per Manufacturer's information: windows,vinyl siding,roofs Smoke Detectors(Fire Department)
and woodstoves
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON T - PREMISES
Certificate of Occupancy -
Building Inspector