17C-096 (4) n
N
UL; _
Z
� ° cn O
4 Z
..1 M
i � a
Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 514, _ /-5 3 _7 Alterations
NORTHAMPTON, MASS. ` � 5--
19"
Additions
' APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location r ' -> l(6 f L-' c'—,-r (' Lot No./
2. Owner's name Address -G
3. Builder's name Address
Mass.Construction Supervisors 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 -at 94'-2-
13. Siding house
14. Estimated cost:- f/e,�cx
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible app, cant
Remarks �.- (L�� �--� � �l �" � �"L 9 � �. �� � [-��
OAK 1tMf PTO
of 'Norf1julliptoll _
s +' fi�asaxc(�u8e(!a
za DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Klass. 01060
HOMEOWNER LICENSE EXEMPTION
_ ( Please Print)
DATE:�^ U H J2 G - f
JOB LOCATION:
(Map) (Parcel) ( Subdivision)
HOMEOWNER: t,;b•�-'? '7( D ( ZZ f t / -
/� (Name & Address )
/ i4
/1,6--3 1,6--3^ 7
/ �-r'e-c? 7� 1 .
(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.
r
c-;
c `.�z
HOMEOWNER SIGNATURE �r ?
BUILDING PERMIT #
a a Crx 'Nart11ai1tpfoil
x
g JUN 2 51997a3arrrllusrrla
Q; DEPARTMENT OF BUILDWG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
'9VORKER'S COMPENSATION INSURANCE Arl MAWT
(Il CC7LSC:�j�erIili ti.�'C}
with a principal place of business/residence at: /
do hereby certify, under ,he pains and penalties of perjury, �iai.
O I am an employer providing the f011n,""in g �.�orr er s compensation coverage for my
employees worming on this job:
(Iasa=cc Company) -- (Policy Number) --- (Expiration Date)
O I am a sole proprietor, general contractor homeowner.1(circle one) and have hired
the co ntractors li st ed below wh o have the fo110 wng wo`r;Fe's compensation p oliies:
(Name of Contractor) (Insurance Company/poky Ntrnlbc:) (Expiration Date)
(Name of Contractor) (hLurancz Comnan)1/Policy Number) (Expiration Date)
(Name of Contractor) (Lasuranc_- Compasy/Policy Niurbxr) (Expiration Date)
(Name of Contractor) (Lnsuran�Compary/Poky Number) (Expiration Date)
(atiachadditiooal shod ifnccc to includc �oo pertaining to all oo�adon)
( ) I am a sole proprietor and have no one working for me.
(,�-I am a-home owner performing all the work myself.
NOTE:plcaac to aware that whilo homcowacra who cmplay persons w du a omsnx ioa ar rcpaa wort;on a dwelling of
not more thin three units is which the housoowocr asides or ec tbo gouatls appurtmani tbc_ o arc not generally cowidcrcd to be
cmployrr3 under the svcxlccr`s lion Act(GL152*r3 1(5)�twdcabon by a homoovmcr for a license cc permit may cvidcaoc the
legil ciauu of an ccaployec under tin Wodooes Compomatioa Ad
I understand that a oopy of thin rtareracai may bo farsvarded to tbo I?cpartm n2 of L,dusai e!A—&,-&OfSoo of Imura000 for tho
covcrs gc verification and that failum to accrue cover under scctiou 25A of MGL 152 can lad to the impositiou of cumin Pcaaltics
oomisting of a floc of up to S 1-500.00 and/or i mprisoamcai of up to occ year and civil pcnatlics in thcform of a Stop Work Order and a
find of S 100.00 a day agstiasi ttz-
Signed this 1 S day of J CY vi --C 199 7 For dcpu1i>xt31—001y
�) Pcrmit Number
%�-C��'�'��,��.r`'�j':L'L z'�'•-��----�.__ Maps Lot#
gnatnre of Licensc&Pcr=Ucc
10. Do any signs exist on the property? YES NO t�
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 cols to be filled in
by the Bnildiag 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:
4 vol-time--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DA'L'E: APPLICANT's SIGNATURE
NOTE: lasuanoe of a zoning permit does not relieve an' AWPpiloantn bu r-derf to comply wit4,,pll
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission. Department of Publio Works and other applioabla permit granting authorities.
FILE #
JUN 2 5199
Fi1e No. �� 1
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL/INFORMATION
1. Name of Applicant: CA E'_,l 7'�. �� r ( /!i i
7 _
Address: h c1 Telephone: 3 ,F ,
2. Owner of Property:
Address: �� t c��T -S .L Telephone:
3. Status of Applicant: 11Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:Parcel Id:Id: Zoning Map# Parcel# �h District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed UseM/ork/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/Variance/Finding ever been issued for/on the site?
NO \'/Pe 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)
FILE
JUN Z 5 1997
APPLICANT/CONTACT PERSON: �� �J2ZQ�,, ,6Y(v%55 '7
ADDRESS/PHONE:
PROPERTY LOCATION: `�
MAP /7 C_ PARCEL: ZONE��� _.
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM MLED OUT
Fee PA
Fee Pnifl
✓�
THE OLLOWING 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 Approval-Bd of Health Well Water Potability-Bd Health
_Permit from Conservation mmission
Signature of Building or Date
NOTE:Issuance of a zoning permit does not relieve an appiloant's burden to oomply with all
zoning raquirements and obtain all required permits from the Board of Health, Conservation
Commisslon, Department of Publio Works and other applicable permit granting authorltles.
R
City of Northampton REQUIRED INSPECTIONS
� BUILDING DEP ARTMENT 1. Footings and Walls
2. Structural Components in Place*
3. Complete Building*
No. 578 Office of the Building Inspector
Zoning Form No. 962450 Date 6/25/97 Fee $20.00 Check# 707
Page, 17C Parcel 96 ,Zone_R_ Section 127 ❑ Yes No
BUI]LDING PERTVHT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Robert Whitman before Building Inspections
has permission to shingle roof over existing 1 layer Inspection on Site—Foundations
situated on 140 Chestnut St 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
** Install per Manufacturer's information: windows, vinyl siding,roofs
and woodstoves Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS AC O MISES
Certificate of Occupancy
Building Inspector