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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. g Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location 1 oZ l`/QR-T rl h4ft E- .Sn?MT Lot No.
2. Owner's name_�}v r,� r R 8 C1T'T' Address 17 a. Jim&OL 914 P1,e- a MT
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration ::M[<F AJa&jAj GXISM)MC 131PiLIi/yl,� lT im �PQ/Al6<
6. New Porch
7. Is existing building to be demolished? Y_ -S
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating F✓I - -
11. Distance to lot lines IV f�rr
12. Type of roof 4SP4*— ,-r S,µ/hIGLr"s
13. Siding house C--,0.0
14. Estimated Cost:-
The undersigned certifies that the above statements are we to the best of his, her
knowl a and belief.
Signature of responsible app icant
Remarks
�, Crxt of Nort4aiuptou x
81991 assacfinsctts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building 'o
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFMAVIT
with a principal place of business/residence at:
-7a �' bj-r'�1,J= 579.W#-7— (phone#)
(streei/city/staiP/�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:
(Lm `anCE Company) (Policy Number) (Expiration Date)
( ) 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 Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additioml sheet if nearsary to inehxle inforuutioa pertaining to all ooabmd )
( ) I am a sole proprietor and have no one working for me.
(L.�am a home owner performing all the work myself.
NOTE:please be aware that while homeowners who employ pc=m to do maadcnancce,mmintction or repair work on a dwelling of
not more than three units in which the homeowner resides or on the grounds appurtenant thereto are not gcoeraky 000ndered to be
employers under the workces oonipcasatica Act(GL152,ss 1(5)),amUcaricn by a homeowner fora license or pcmit may evidence the
legal status of an employer under the Worker's Companatioa Aar.
I underuand that a copy of this statcment may be for warded to the Department of Iudu,n d A=dcc&OfSioc of Inauance for the
coverage verification and that failure to accrue oow-mp under section 25A of MGL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to SUOO.00 and/or kaprbomnent of up to one year and civil penalties in the form of a Stop Work Order and a
firm 0(3100.00 a day against mo.
Si this a q da of 1991 For d rue oaty
Permit Number
Map#_ Lot#
St of LicenseelPermittee
OQ CIW lP�O
(rzf trf Ncr f[Taillptall M
8
%7281997 ,�aseaef�uatile
DEPARTMENT OF BUILDING INSPECTIONS -
INSPECTOR 212. Main Strcct ' Municipal Building
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
n ( Please Print)
DATE:
JOB LOCATION:
(Map ( Parcel ) ( Subdivision)
HOMEOWNER: � U� MRl4'T'T
(Name & Address )
�!7a�a �I
-
( Home Phone ) (Work Phone )
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one ( 1 )or t%•m (2) fami 1 ieS 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 Annotate
HOMEOWNER SIGNATURE
BUILDING PERMIT #
1& 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 property?YES NO
IF YES,describe size,type and location:
11 . ALL INFORMATION MIDST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
Thin C01— to be filled in
by the Building Arpartment
Required I
Existing Proposed By Zoning
Lot size
Frontage j
Setbacks
- side L: R: L: R: j
- rear � v
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
# of Parking spaces
# 'of Loading Docks
Fill:
_(volume -& location)
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
DATE: APPLICANT's SIGNATURE
NOTE: luounnoe 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 applionble permit granting authorities.
FILE #
n 8 !997
File No.9d"�V(p/
ZONING PEM11T APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: ?P'VkA'
Address:) 0isi f h4'?h97 SRWT Telephone: 3-y10— �bt35
2. Owner of Property: ?4VL4 a--a C--/�
Address:JAl bo R rtt � �� ��Q�'D'7"-- Telephone: S-76 '306 S
3. Status of Applicant: f Owner _ Contract Purchaser Lessee
Other(expplain):
4. Job Location: /`f� /Voxr/l� 1,g Simay—r—
Parcel Id: Zoning Map# 1�_ Parcel# _ District(s): Ll �''
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property SJt�A6Ls
(
6. Description of Proposed se/W k/Project/Occu abon: Use y)
e ition 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?
t/
NO DON'T KNO:%r_ 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 # _ 96 ?361
APPLICANT/CONTACT PERSON: .Gtr � .7 1� ,56653
ADDRESS/PHONE:
PROPERTY LOC TION: 17
MAP PARCEL: , ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERNUT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FH.T,FD OITT
Fee Paid
lRidid n2 Permit Filled nilt
G O —
Type of C'onstnirtion-
ArrPs,nry ,';triirhire
nild nu Plan-, Inrliirled-
'i SPtc of Plan, /Pint Plan _
THE FOLLOWING 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 Enclt
Finding Required under: § w/ZONING BOARD 0 �
pw
Received &Recorded at Registry of Deeds Proof En(
Variance Required under: §_ w/ZONING BOAR] � � /�
Received &Recorded at Registry of Deeds Proof Enc
Other Permits Required:
Curb Cut from DPW Water Availability y
Septic Approval-Bd of Health _Well Water Potability-
!Permit from Conservation Commission
Signature of Building Inspector Date
NOTE: Issuanoa of a zoning permit does not relieve an applioant's burden to oomply with all
zoning requirements and obtain ell required permits from the Board of Health, Conservation
Commisslon, Department of Public Works and other applicable permit granting authorities.