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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
' APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location C � Lot No.
t c�,f l3 cT'T
V2-. Owner's name �64u � /�� Address
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
i,�. Alteration PF-140 V& y4d-TE - ��t�t,/tC _ �' T4
6. New Porch
7. Is existing building to be demolished?
S. Repair after the fire
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines
V42. Type of roof N64-C7
13. Siding house
vsY4. Estimated cos J
The undersigned certifies that the above statements are true to the best of his, her
t,,knowledd belief
L ;
Signazure of responsible apps cant
Remarks
Grz#� of Norf umptau
� T
DEPARTMENT OF BUILDITNG INSPECTIONS '
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060 " ,
HOMEOWNER LICENSE EXEMPTION
DATE: � 9�9� (Please Print)
JOB LOCATION:
(Map) ),parcel) (Subdivision)
HOMEOWNER: ��U LFI- d✓P - �Y�' �T j�
(Name & Address)
17 �p2 Ttt P4-Pl,E S7` -
(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.
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HOMEOWNER SIGNATURE
BUILDING PERMIT # y „
O�Ct�P�C ( `19",
�$ Crib of 'Wart allyton M
$ 6 �Tassac[ynsrtts
DEPARTMENT OF BUILDWG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
g v
(licensee/permittee)
with a principal place of business/residence at:
(phone#)
(street/ ty/stet Zip)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following workels compensation coverage for my
employees working 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) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insn-ance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insa ante Company/Policy Number) (Expiration Date)
(Poach ad&tioaal sheet ifneoesmy to include information pertaining to all ooa radon)
( ) I am a sole proprietor and have no one working for me.
(44-1 am a home owner performing all the work myself.
NOTE:please be aware that while homeowners who employ petsans to do ma;dMac,construction or repair work on a dwelling of
not more than dace units is which the homeowner resider or an tba grounds appurtenmt tbaeto are not generally considered to be
employers under the vmd='s compensation Act(GL152,ss 1(5))�application by a homeow=for a liaise or permit may evideooe the
legal status of an employer under the Workeet Comg�Act
I understand that a copy of thin statement may be forwarded to tbo Depnrtmcos of Industrial Ao idw&O&oe of Imwraoce for the
coverage verification and that failure to soaue coverago under section 25A of MGL 152 can lad to the impoidion of criminal penalties
000sisting of a fine of up to$1.500.00 and or impriaonmeut of up to one year and civil penalties is the form of a Stop Work order and a
fine of 5100.00 a day against tae
Sign _ y of /mil/1Y 1995 For dep,au=w use only
L-1 �- l" Permit Number
Map# Lot#
r Signal nre of Licensee/Permittee
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 columm to be filled in
by the Building 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
f of Loading Docks
Fill:
4 vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my kno edge./
,-DATE: _5 =� ' �, APPLICANT'S SIGNATURE r0-L
NOTE: lasuanoe of a zoning permit does not relieve an appiioanra burden to oofnplY wit4,,al1
zoning requirements and obtain all required permits from the Board of Health, Conservetlon
Commission, Department of Publio Works and other applionble permit granting authorities.
FILE #
9 !99
File No.96-,dC).)('0 I
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE, OR PRINT ALL INFORMATION
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Name of Applicant: i)t-,i4—
-Address: /7e`� bo 4-T-0y Zff >-7` Telephone:
2. Owner of Property: lyl
Address: ef t F Telephone:
3. Status of Applicant: Owner _ Contract Purchaser Lessee
Other(expllain)J: —y,�
4. Job Location: 19 �® ?
Parcel Id: Zoning Map#r�_ Parcel# X70? District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property f ,
inscription of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
Q:e-ho v6 S[ 1 r
r
kP 4 y
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 DON'T KNOW_ i/ 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 # 9 �
V'Z?PLMANT/CONTACT PERSON:
ADDRESS/PRONE:
PROPERTY LOCATION: '�
MAP /'7� PARCEL:—,,-:.,"C. ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERNIIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM M.>i ED OUT -
Fee Pal/1
Rnildinv Permit Filled ()11t
Fee Pairl "1 ��(� YO ✓ �ls
1
Arrecgnry Stmirtnre
TBPE OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION'
�/Approved as presentedfbased 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:§ WZONING 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
�-Id 7
Signature of Buildin In;p r Date
NOTE:Isauanoe of a zoning permit does not relieve an applioant'a burden to oomply with all
zoning requirements and obtain all required permits from the Board of Heaitho Conservation
Commiaslon, Department of Public Works and other applicable permit granting authorities.
A�° -�: City of Northampton REQUIRED INSPECTIONS
1. Footings and Walls
BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
NO. 375 Office of the Building Inspector
Zoning Form No. 962226 Date 5/12/97 Fee$D;0.6t Check# '7
Page, 17A Parcel 220 ,Zone URB Section 127 ❑ Yes ® No
BUI]LDINGPERMI F-I
*Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Paula Corbett before Building Inspections
has permission to strip slate,install plywood,reshingle roof Inspection on Site—Foundations
situated on 172 North Maple 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
Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON THE PREMISES
T '
Certificate of Occupancy
'Yujlding Inspector