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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. S` Alterations
NORTHAMPTON, MASS. - 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location l 9- Lot No.
2. Owner's name Address
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition X142
5. Alteration 2n.,
6. New Porch /v P,
7. Is existing building to be demolished? V"y
8. Repair after the fire
9. Garage .I!' No.of cars Size
10. Method of heating &1)1
11. Distance to lot lines N
12. Type of roof k l7
13. Siding house ZL l�
14. Estimated cost:- G� G L;
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
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Signatur of responsible 4p,icant
Remarks -
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Ft� UqP' 'UgX,tJ. WENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
,F
with a principal place of business/(esidence t:(stmet/city/stale/zip)
do hereby certify, under the pains and penalties of perjury, that:
O T am an employer providing the following worker's compensation coverage for my
employees working on this)ob:
(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) (I.nsurance Company/Policy Ntlmbcr) (Expiration Date)
(Name of Contractor) (insurance Company/Policy Numbe,) (Expiration Date)
(Name of Contractor) (Insuranc,. ComPan}"/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach amitiomi ibcef if nee to include infxnuIIoa perhining to dH covfrncion)
( ) 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 mbilo homcowom wno employ persons to do maireminr e construction cr repair work oa►dwelling of
not moro they three traits in which the bomoow=reside or oo the grounds 2pptrrtcnaat:hasty arc not gcoczatly,oowidcrrd to be
employers under tbo wockc satin pct(GL152,ss t(5)),application by a homcow=far a license or permit may cvid0Icc the
Icgal rutu of an employer under tic Wockcez conv-u ioa Act
I undctHand thst s copy of this=tat.cmcat way be forwarded to tbo Dcpcvtmcot of Indwtri al Aocidw&offioo of Iuwrwoo for the
oova2ge vcrificatioa and that failure to&titre coverage trader soctioa 25A of MGL 152 can lead to tho imposition of criminal penalties
oomistiag of n f oe of up to S 1,500.00 sr N-impri30aracai of up to om year sad civil pcmltia in the form of a Stop Work Order and a
firm 0(5100.00 a day tg&inA me_
Si this day of 1995 Fardgzntr�u,00nly
Permit Number
�, ✓' Y s lvfap I,ot#
sigaatult ofLic=seelPe 'tire
.�oQ„KNMlplO� �-\
08 yYlRS6H ell Ito tI Is
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jARTMENT OF BUILDING INSPECTIONS
INSPECTO ' ' : -i°"'"` X12 Mnin Street ' Municipal Building
Northampton, Mass. 01060 °
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE:
JOB LOCATION:
(Map) (ParcelV2 ubdi sion)
HOMEOWNER
( a'me & Address )
or
'(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.
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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 # +
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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.
h _ This col— to 2>e filled in
by the Building Departarnt
11 I Required I
Existing Proposed By Zoning
I Lot size
Frontage
Setbacks
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&peved parking
# of -Parking Spaces
ht of Loading Docks
Fill:
-(volume -& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: APPLICANT's SIGNATURE
NOTE: luauanoe of a zoning permit does not relieve an applioan�urde-n mp with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commisslon, Department of Publio Works and other applionble permit granting authorities.
FILE #
il 31
Fe No. � /
Tr elf
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address:- -Telephone:
2. Owner of Property: —
Address: elephone: Pen_X____
3. Status of Applicant: ✓ Owner _Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# /Z Parcel#027 District(s):�„� _
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property /U ' 71a-�-zd�4
6. Description of Proposed Use/Wor roject/Occupation: (Use d`ditiioona sheets if ne I ce
ivsvrry�,�Z 2r F,
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.
5. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW V" YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW i/ 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 # n n
{ FEB 3 i9w
PLICANT/CONTA T PERSON: d� ; L i 5 =� a7�� 171 7
SS/PHON
r...3
PROPERTY LOCATION:
NLA,P J'1' PARCEL: X71 ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Fee Paid
Fee pnifi re /
Type-of Constnirtion-
.Remcidelin2 Interior zry�
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TWOLLOWING 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
Signature o Building ector Date
NOTE: Issuanoa of a zoning permit does not relieve an applloant's burden to oompty 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 authorlties.
. e Cit y of Northampton "QUI"D INSPECTIONS
BUIULDING DEPARTMENT 2. Footings and Components in Place*
3. Complete Building*
No. 1270 Office of the Building Inspector
Zoning Form No. 963196 Date2/4/98 Fee $40.00 Check# 1
Page, 17C Parcel 271 Zone upB Section 127 ❑ Yes ❑ No
BUI]LDINGPERNM
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT_Doreen sparling & Sylvia Howes before Building Inspections
has pernmission to remodel kitchen & bathroom Inspection on Site—Foundations
situated on 41 Lilly St - #39 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
Smoke Detectors(Fire Department)
_ Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON74E PREMISES
Certificate of Occupancy
Building Inspector