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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 5 y yy� Alterations
NORTHAMPTON, MASS. T�G 191-7 Additions
' APPLICATION FOR PERMIT TO ALTER Repair X
Garage
1. Location y0 '�t4h0 'c,,Pa11T Lot No.
/`
2. Owner's name n n 6 Nn 771 u/2D/0V N Address y .� i N� Co i//Zr FIX9 ''A.,c-C'
3. Builder's name 64cb o/z y -zeXtz7 ew9Aj Address Ail c//"-"' 1�=GpIt rNc e
Mass.Construction Supervisor's License No. Q t y 74 Y Expiration Date Y
4. Addition
5. Alteration
6. New Porch
7. Is existing building to be demolished? /�✓y
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof 5 T,n1N 5/}IN�re `s (�yts,�t /r./UM 4W yt /1 yf/`/'l'Gt�
13. Siding house
14. Estimated cost:- ;0()t vo
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible app lcant
Remarks
�-tttA>(pT
O O
JUL 3 1 1991 Gift of 'Wnxfilaillpfoll .
9 B Massachn'scIto -
DEPARTMENT OF BUILDDIC INSPECTIONS —
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORZ<ER`S COMPENSATION INSURANCE AF MAVTT
7,akl , ConGtruction Serviees
(Ji�nsc�/�rmi tree)
with a principal place of bttsiness/residence at:
41 Avis Circle, Florence (pbonefr) 584-4069
(st�-e;.t/ci t}'/stairJn p)
do hereby certif),, u-oder the pains and penalties of perjury, hay:
( ) I am an employer providing the following rror',er's compensation cove:-age for my
employees woridng on this job:
The Ti:av l arg _ 009 C 25592079 TCA
(Lnszuanee Coi g- y (Policy Dumber) (Expiration ate
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worket's compensation policies:
(Name of Contractor) i--c-- Company/Policy Number) (Expiration Date)
(Name of Contractor) (Lasurancz- CompanyiPoUcy Number) (Expiration Dale)
(Name of Contractor) (asurancz- Company/policy Numbu) (Expiration Daie)
(Name of Contractor) (Lasurancz- Company/Policy Number) (Expiration Date)
(etc..-fi xdditioml nccci ifnoo—y to inf"'EOa pert- ng w an wdr-.-Con)
( ) I am a sole proprietor and have no one worldq for me.
( ) I am a-home owner performing all the work myself.
NOTE_please be awJ,nc chit N bi o homcowom t+4o cmplay persom to do n ird ,•, c oc-or rcpaa work on a d.4-ll of
not more xb-n thr oo trait+is whicti the bomoowncr raido or oa the grounds:pputtcauA tbcrctn arc not gcn.-.4 ooaAdcrcd to be
ca�sloym under tba worktt':ecmpcmdien Act(GL152=l(5)�application by a bomcowmr far a Gcco=oc p=m3d may cvidcaoc the
legal etama of an cwpployec under the Wockcea Comptna&Gon AeL
I understand the a copy of tbia mtemcur may bo f,-,,r d<d to tlx Dep.,tn t of Lodutsi a1 Aood4ca OISoo cC Ia;srcaooa foe rim
coverage vcri csdoa and that failure to secure oovcrabo under sodion 25A of MOL 152 cm Iced to tbd imposition of mmiasl Pcaaltics `
oomismrg of•-l_me of up to s 1,5oo.00 and/or kVriso®c at o(up to ooc year and avta p®lact io the form oCa Slop Work Order and a
linooCS100.00allay agrtinst.tnc.
Signed this _day of A6 1997 For dcpatmceL1ua000ly
Permit Number
Mapg L40t it
Signs f I:iocnscvPc>:mitxcc
r I •
10. Do any signs exist on the property? YES NO � 3�
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 —lama to be Pilled in
by the Banding Department
Required
V 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)
.pf 'Parking spaces
of Loading Docks
Fill:
Avol-time--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
_a r
D E: - G `�_� APPLICANT's SIGNATURE
NOTE: Iss ano of a zoning permit does not relieve an—appilgAnes burden to comply with,rpU
zoning requirements and obtain all required permits from t e Board of Health, Consery ation
Commission, Department of Publio Works and other appiioable permit granting authorities,_
FILE #
„ 3 1 1997
File No.
ZONING PERMIT APPLICATION (510 . 2
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: C-0NjTAk1Cj'1U1U 5- ell v)CC5
Address: Telephone:
2. Owner of Property: X06 Oe
Address: 1911�NU COWIL7 Telephone: `) 9 "fl F?y
3. Status of Applicant: Owner X_Contract Purchaser Lessee
Other(explain):
4. Job Location: yU ���1�0 CQctltT
Parcel Id: Zoning Map# 4:22 Parcel# District(s): �
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property_ t+V Jul a fJ r,*i)y)G y
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
5TI21P ,s#iyC/'es Fluor C'"Oe VL /l e S/fJ)vGzC
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 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_V-' 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 # 9G :26-13
a
i 7
j, 3AIPlffi7CANT/CONTACT PERSON: 2akc- �� ��f•�Z ,t''�,, ���� {J(
ADDRESS/PHONE:
PROPERTY LOCATION:
MA-P---a 9 PARCEL: /,2z Z
THIS SECTION FOR.OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
7.0MENG FORM EMIED OUT
Bididing Permit Filled mit
14--1
T 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 C mission
Signature of Building Date
NOTE:Issuance of at zoning permit does not relieve an appiioant's burden to comply with ail
zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
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