05-068 (4) a
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Y Alterations
NORTHAMPTON, MASS. 19
Additions
APPLICATION FOR PERMIT TO ALTER Repair
,,�` Garage
1. Location b ` ` '�`"' "t� �'� Lot No.
2. Owners name 1. {�< ►. Address
V �i Q tJ t�1
3. Builder's name j.. `l�� '�� v#AA Address
Mass.ConstruKcj)c on uRervisor's License No. Expiration Date
4. Addition X 7 lZ-
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. Estimated cost-O,�_S—u-o --�
The undersigned certifies that the above statements are true to the best of his, her
k wleddge and belief
Signature of responsib%app,icant
Remarks
o °® Grif� oaf Norfira»tptali
r f R66AChlistIIs '
�t
cs. DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
DATE
Alvt � (Please Print )
• `t "l
JOB LOCATION:
( ap) .( Parcel ( Subdivision)
HOMEOWNER:
(Name� w i 2ddr s s w
( 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 Annotat d.
HOMEOWNER SIGNATURE
BUILDING PERMIT #
�(1tA�rPl.
20 0
s a Crif-r oaf 'Hart ampturl
9 6 f�lasaxcansrtta
DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATTON INSURANCE AFFIDAVIT
n
(licensceJpermi��ee)
with a principal place of business/residence at:
(phone#)
( city/s�ateJ�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 worlring on this job:
(Insurance 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) (Insuran(--Company/Policy Number) (Expiration Date)
(Name of Contractor) Onsurane,� Company/Poky Number) (Expiration Date)
(Name of Contractor) (Insurancz Company/Po(icy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (E)piration Date)
(attach additioml shod ifneo.ary to include infixmatioa perta;uing to ell oodrnetom)
( ) I a sole proprietor and have no one working for me.
( m a home owner performing all the work myself.
NOTE.please be aware that while homcowncn who cmpiay pczz=to do makdeaxa r,c=strvction or repair work on a dwelling of
WE nW*than than units is which the hmnoowucr r=des or on tbo gouilrs appudmacd th=to an not gcocrally ooandcred to be
—pioy<ra twdcr tho woctccr oompeas4ca Act(GL 152 ss 1(5)),application by a homeowner for a license oc pamd may evidence the
legsl ctatcu of an employer undartho Wocicora Compwsation Act
I understand that a copy of the r atcmcat may be forwarded to the Dcpe b,,3, R of Industrial Az6dcc&Offioc of Iasuranco for the
coverage va ificatioa and that failure to aecuro covctago under section 25A of MOL 152 can lead to tbd imposition of criminal ptxiaW-
aomisUng of a Sine of up to$1,500.00 and/or imprisoamcat of up to one year and civil pemttia in the form of a Stop Wort Otdcr and a
find of 5100.00 a day against me,
For
dcpaytmr�al use°aty
Permit Number
Nfi(0 _Lot#
...gnabnv-of LiocnseeRcrmittee
JAN
N\A V
CL
ry
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 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 COIU= to be filled in
by the Building Depax- nt
(Required I
Existing Proposed By Zoning
Lot size
Frontage 2 Go
Setbacks '= :7 i 40
- side L: R: L: ''° � R: '
- rear
Building height
Bldg Square footage
%Open Space: y
(Lot area minus bldg i
&peved parkiogi
# pf Parking Spaces --_
e 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 wledge.
DATE: (_-a APPLICANT's SIGNATURE `^NOTE: laouanoe of in zoning permit does not relieve an applicants burden to oomply With 4411
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appiioable permit granting authorities.
FILE #
J U 4
1L t File No.
cR ..
U. - ""° ZONING PERMIT APPLICATION (§10 . 2
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: ��� �.tLni-J Telephone: ' Vu—t�
2. Owner of Property:
Address: ('A`( '�— Q Q V's 0-kil V1 Telephone: < b ' OC i
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): 4
4. Job Location:
Parcel Id: Zoning Ma p# � Parcel# O
g p _� Districts
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property s�\ Cz
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
7. Attached Plans: Sketch Plan Site Plan F,...°' 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 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)
,E # 963
as -
- ZONE
5 '1� ..TIO N FOR-OFFICIAL USE ONLY:
+ [IT APPLICATION CHECKLIST
C.crn` -uo-, CNI (R GVM r � ENCLOSED REQUIRED DATE
Ff-P Paid
Addition to Existing X61-1
__
f�wnPr/(1 __-
�.
TBE FLOWING 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 Commission
Signatur ate
NOTE:issuance of oning permit does not relieve an applloant's burden to comply with all
zoning requirements and obtain nil required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authoritles.
ADO `S City of Northampton REQUIRED INSPECTIONS
1. Footings and Walls
BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
NO. 1414 Office of the Building Inspector
Zoning Form No. 963286 Date 4/3/98 Fee$40.00 Check# 372
Page, 5 Parcel 68 ,Zone RR/WSP/WP Section 127 ❑ Yes No
BUI]LDING PERNM
s
*Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Luis Isaza before Building Inspections
has permission to coantruct attached deck Inspection on Sites-Foundations
situated on 671 Kennedy Rd Inspection of Plumbing—Rough
**Certificate of compliance "as built plan" needs to be provided Inspection of Plumbing—Finish
provided that the person accepting this permit shall in every respect
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 tern-is 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
Building Inspector