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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. -XZ-q Alterations
NORTHAMPTON, MASS. Additions
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APPLICATION FOR PERMIT TO ALTER Repair
e/ Garage
1. Location r Lot No. ,
2. Owner's name Address /V� ���2 l f'/dlLsf' dl6(
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
6. New Porch
7. Is existing building to be demolished? io
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof 22- /12r
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
ignature of responsible appocanl
Remarks
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a ocr 2 01997Crz# f 39arfilaillp foil
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DEPARTMENT OF BUILDING INSPECTIONS -
INSPECTOR 212 Main Street ' Municipal Building '�y
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
( Please Print )
DATE: C
JOB LOCATION:.
/ (Map) ( arcel ))._ , ( su vision)
HOMEOWNER: Z-)
(Name & Address )
cSoQ(
( Horne Phone ) (Wof7k Phone )
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one ( 1 )or tti,,o (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 ##
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€ m DEPARTMENT OF BUILDING INSPECTIONS
�j 212 Main Street ' Municipal Building
_ O Northampton, Mass. 01060
N
WORI{ER'S COMPENSATION INSURANCE A.FMI AVIT
Jo6 a.,Qk' 74 00 /L Ze,
(litxnscrJperr»ttec)
with a principal place of business/residence at:
_Lz'7� //� / �" d !6 (phone
(strcet/ci statrh�p)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following,,,iorker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Dale)
( ) I am a sole proprietor, general contractor o homeowner circle one) and have hired
the contractors listed below who have the following wor e s compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
f
i
(Name of Contractor) (Insurance Comp-my/Policy Number) (Expiration Date)
l
(Name of Contractor) (Insurar ce Company/PoUcy Number) (Expiration Date)
(attach addit=,i sheet if necessary to include infoml Lion pertaining to all eo traclon)
I
( ) I am a sole proprietor, and have no one working for me.
( 1 am a home owner performing all the wcrk'myself.
NOTE:please be aw-4m that whilo homcowncra who employ pczons to do mainf- constr c oa cr repair work.ou i dwelling of
not more thsa three units in"-Etch the bomoowucr rtaldcs or oo the Vouaeis appuitcnsexl thacto me not Ctoc ally oomidcrtd to be
cmploym under the worktt'i oonV—satioa Act(GL152ss 1(5))�application by a homeowner for a Uccn=or permit may evidence the
legal"I"of an nrnployec under the Worked[Cornpoosstion Act
I undasiand that a oopy of thu ctatemcat may bo for,, ted to the Dcpertnamf of lodustrid Accideah'Offoo of lnA"'-Q0`for the
eovaxge verification and that ft-d=to Secure oovtrngo undo section 25A of MOL 152 can lead to tho imposition of a'imiwd pemalties
eomistiag of a&ae of up to S 1,500.00 uWor bnprisomm nt of up to one)isr and avid pcmtties is the focm of a Stop Work Order and a
film of S 10.00 1 day L&dasl mG
Signed this_ 7z5 VA day of 1997 FCC&Patmaatal—only
Permit Number
Map# Lot#
signature of Li ctuuittce
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 MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This —1-= to be filled in
by the Building Department
I Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - front
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&pa.ved parkin-1
#
of -Parking spaces
tfof Loading Docks
Fill:
A volume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
7
DATE: / ZI: ' APPLICANT's SIGNATURE,
NOTE: Issuance of oning permit does not relieve an applioan s rden to oomply with all
zoning requiramen and obtain all required permits from the Board of Health. Conservation
iCommission. Depa ment of Publio Works and other applioable permit granting authorities.
FILE #
' v.a
MT 201�, . i
9,/,
�J
File No. o1 9j
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:\�1A/?12
5�_
Address: � _ P �? Telephone:
2. Owner of Property: �?-e
Address: Telephone:
3. Status of Applicant: Owner _Contract Purchaser Lessee
Other(explain`) o��
4. Job Location: �/��
Parcel Id: Zoning Map# Parcel# 11,5�- District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5, Existing Use of Structure/Property /
6. De bon off.Proposed UJ e/Work/Project/Occupation: (Use add itional sheets if necessary):
113'e-Li 1 fP yJ` i� .l�C?1t'l✓i �i'U D T �%y�� .�/��£'C��
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 k/ 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)
FILE # 967J20 �
OCT 2 0 1997
APPLICANT/CONTACT PERSON:
ADDRESS/PHONE:
PROPERTY LOCATION:
MAP ARCEL: /, ZONE
THIS SECTION FOR.OFFIML USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FULED OUT
13nilding Permit Filled ntit
>✓�
7S
LC �` ,,�
Arressnry Structure
f-�— xyngdOrrnpant Statement or License H
THE LLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATIOM
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 Healt.4 Well Water Potability-Bd Health
-kvmit f n CiyrSe to ssion
Signature of Building4ffspector Date,
NOTE:Issuanoa of a zoning permit does not relieve an applicant'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 applicable permit granting authorities.
City of Northampton REQUIRED INSPECTIONS
BUILDING DEPARTMENT 1. Footings and Walls
2. Structural Components in Place*
3. Complete Building*
No.
1012 Office of the Building Inspector
Zoning Form No. 962920 Date 10/22/97Fee $20.0 0 Check# 6275
Page, 17A Parcel 212 ,Zone URB Section 127 ❑ Yes 0 No
BUH- -JDING PERTVHT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT John Szawloswki before Building Inspections
has permission to strip & shingle porch roof Inspection on Site—Foundations
situated on 126 North Maple St Inspection of Plumbing—Rough
provided that the person accepting this pen-nit 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
** Install per Manufacturer's information: windows,vinyl siding,roofs Smoke Detectors(Fire Department)
and woodstoves
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON T P ISES
Certificate of Occupancy
Building Inspector