35-147 (5) a
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. ry Tel.No. Std b .� � Alterations
a NORTHAMPTON, MASS. Ia A 9G 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair it e S
S
/ l Garage_'r` `3
1. Location A V G� Lot No.
A2. Owner's name FYI A. IL u cv c. t� Address I LI c't 1,
3. Builder's name Lt-A A ��Yvr�N C - Address 71 q b y
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration rj r- '-j C4 { .
6. New Porch
7. Is existing building to be demolished? `;")0
8. Repair after the fire
9. Garage ye S. No.of cars Size a a-A► X 0
10. Method of heating t"3 C� ;3 V-'r
11. Distance to lot lines
12. Type of roof PoO t -
13. Siding house° t '
14. Estimated cost:-/�i,JD i.r0
The undersigned certifies that the above statements are true to the best of his, her
knowledge anddklief.
6 � ,
Signature of responsible app ican!
Remarks
lif� of 'Nar#1jamptall
$ H M ago RC11 Ito ON "
OGT 1 610
DEPARTMENT OF 13UILDING INSPECTIONS
INSPE TQPT OE SUII(a!►m 212 Main Street ' Municipal Building '
Northampton, Mass. 01000
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE: ,✓ G > J' 1�►
JOB LOCATION:
(Ma ) (Parcel)/ ( s divas}Io )
HOMEOWNER: �G r/ //
(Name & Address) ,
(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.
HOMEOWNER SIGNATURE !. - `: /
BUILDING PERMIT #
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°"'r
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This color= to be filled in
by the Building Depaxti nt
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
Lot area minus bldg
' &paved parking)
# ,�f -Parking Spaces
_f of Loading Docks
Fill:
'4vol-ume--& 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_,/ <C ;
?" NOTE: Issuance of a zoning permit does not relieve an appiioant's burden to oom wit
Ply . +4� !
h
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publlo Works and other applioable permit granting authorities..;_
?'.?',t FILE #
-----____-- -___-
UH \
� FiIe No'
DEPT OF BUILDNG
\x~ "�^ � � ��=� T = PP^ XC=TXON (§10 . 2)
PLEASE TYPE OR PRINT ALL ZNFORMAZ10N
1. Name of Applicant:
-
Address: 71Z t, Telephone: 2
or
_ Owner of Property:_
Address: .02 41 ohona
3. Status of Applicant: owner -Contract Purchaser Lessee
Other(explain):
- \
4. Job Location:
Parcel Id: Zoning Map District(s):: v
(TD BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use ofStructure/Property
S. Description of Proposed Usa8Akork[,rojeuVOooupoUon: (Use additional sheets ifnenosmaqy):
^ L
7. Attached Plans: Sketch Plan Site Plan nginoomd/Sun/eyedP|ana
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8� Has a Special Perrnit/Vohanuo/Finding ever been issued foobntho site?
N DON'T KNOW YE2 iF YES,date issued:
IFYES: Was the permit recorded aL the Registry ufDeeds?
NO DON7 KNOW YE
IF YES: enter Book Page L and/or Document
Q. Does the site contain a brook, body of water orweUando? N °A�- DON'TKNOW 9E
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs tobe obtained Obtaineddate issued:
'
(FORM CONTINUES ON OTHER SIDE)
FILE # 961605 � L
AEILWONTACT PERSON: 2
, �SLP,HONE•
PROPERTY LOCATION: Ge
MAP �,''�� PARCEL: JY2 ZONE
THIS SECTION FOR.OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLO D REQUIRED DATE
Fee PAid
Builr1inyr Permit Filled mit
Fp�; Paid
Additinn to Existing
3 . etc, of Rinng I Pint Plan
✓'
G�
THEOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION-
t 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 Com 'ssion
,gj�� - /0 Signature of i 7 Dat
NOTE:lasuanoe of a adheing permit does not relieve an applloant's burden to oompty with all
zoning requirements and obtain all required permits from the 13card of Health, Conservation
Commisslon, Department of Public Works and other applicable permit granting authoritles. _
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