Loading...
29-205 (2) a ° at ZZ= ►U to �� CJ \11 N �. *a l IJ t � � h N 0 D r c v b o � �p m N p O vDi Z m Z > � o Z o -� Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.. Alterations NORTHAMPTON, MASS. ���T—_19 f Additions i Garage APPLICATION FOR PERMIT TO ALTER Repair { 1. Location t 13 FLoa- �&F- Lot No. 2. Owner's name C tfArLE� + c r4.1 H`/ / CII-/ C kT Address f% 09--( 7/,=`7 P'@ f-iO(IAE-PrC6 3. Builder's name P i C t4 A rz I`- I "Y Address Zy Mass.Construction Supervisor's License No. Expiration Date / 9 ' 4. Addition �- s 5. Alteration e-N CL(5,s /-I G- ��Z ,�- Sc��_��L� / ��2 C- 6. New Porch 7. Is existing building to be demolished? /YO 8. Repair after the fire 9. Garage J No.of cars --- Size =--_ 10. Method of heating /nn�C/ 11. Distance to lot lines_ __►0P2 L1d L&--L 12. Type of roof ff—c-d 13. Siding house 14. Estimated cost:- C�; The undersigned certifies that the above state nts are true to the best of his, her knowledge and belief. Signature of responsible app,icant f� Remarks t � d _ V ,.._- evt tiLlf y�ihr, N J li �a 2 �5 ca � _ o - N } N z� r s FEB bo 2 411998 4 n N o _ cs a9 a Q �i I � n N ` I s� FEB 2 4 ►998 Gitz of Narf4antptou +� �la3aarila8ttlf3 w DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building O,y SJ, Northampton, Mass. 01060 # w WORKER'S COMPENSATION INSURANCE AFFIDAVFr (IicenserJpermittee} with a principal place of business/residence at: NW 0-0 (phone#) �L (st=Ucity/sta&2ip) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: (Insurance Company) (Policy Number) (Expiration Date) V),,l am a sole proprietor, general con�ictor or homeowner (circle one) and have hired the contractors listed below who have Te 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) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (ranch additional rhea ifnecenwy to include information pataimng to all ooatmd ) W1 am a sole proprietor and have no one working for me. eV ( ) I am a home owner performing all the work myself. NOTE-please be aware that while homeowners who employ pasous to do maintenance,coasauction or repair work on a dwelling of not mote than three units m which the homeowner raider or on the groins gTudenaat th=w are not gweally considered to be employem under the woricces compcau4on Act(GL152,ss 1(5)),application by a homeowner for a 6ocox or permit may evidcaoe tho legal ctalua of an employer under the Worker's Compensation Act. I understand that a copy of this statccmeat may be forwarded to the Depuuwcd of Industrial Aodden&Offloo of lnseuanm for the coverage vmficatioa sad that failure to secure coverage under se moa 25A of MOIL 152 can lead to the imposition of criminal pe nalbea consisting of a fee of up to$1,500.00 andlor imprisons of up to one year and avt7 pemltia in the form of a Stop Work Order and a fine of 5100.00 a day against tee For dqztrr n use only Permit Number Mao Lot# Sire of LioeaseelPermittee MAR 3 1998 f o 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 siaft•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. Tbia cold to be filled in by the Building Depnrtmcnt (Required Existing Proposed By Zoning Lot size Frontage Setbacks - frnnt A - side L: R: L: R: - rear s Building height Bldg Square footage %Open Space: (Lot area minus bldg &Paced parki.zg) # of -Parking Spaces # '6f Loading Docks Fill: -(volume -& location) 13 . Certification: I hereby certify that the information contained herein G is true and accurate to the best of my knowledge. DATE: - APPLICANT's SIGNATURE NOTE: lasuanoe 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, Conservtation Commission, Department of Publio Works and other applioable permit granting authorities. FILE # ro'b Fo ° p n d can W co A g x :d �? w bd � F: '' 9 m n ° 0 n rt P. a b In CL o OrQ 0 m p,.r o, y >v sr ` r a mo g• ° w co O cu E m � PV Rr o roll, cm n y � o r•. � � �i o' o' o• � o CD tZ Ig O� UQ (1Q N kD t✓ c 0 CD 0 �r E tZ CD ° 0 6 V1 b � :v CD Signature of Building or Date NOTE: Issuanoo of a zoning permit does not relieve an appiioant's burden to oompty with all _ zoning requirements and obtain ail required permits from the Board of Health, Conservation Commission, Department of Publio Works and other applioable permit granting authorities. r � 10. Do any signs exist on the property? YES NO_ tL(, IF YES, describe size,type and location: - Are there any proposed changes to or additions of siP%*intended for the property?YES _ NOK _ IF YES,describe size,type and location: 11 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. This Colin to be filled in by the Efnild..ing Department Required Existing Proposed By Zoning I Lot size - Frontage Setbacks - frnnt - side L: R: L: R: - rear Building height Bldg Square footage %Open Space: (Lot area minus bldg &paved parking) # of Parking spaces 0 of Loading Docks Fill: Avolume-& 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: innuanoa of a zoning permit does not relieve an applicants burden to oomply wit0 i"n zoning requirements and obtain all required permits from the Board of Health, Conservotion Commission, Department of Publio Works and other applicable permit granting authorities. FILE # FEB 2 4 IM File No.4 I ZONING PERMIT APPLICATION (§10 . 2 PLEASE TYPE OR PRINT ALL INFORMATION �1� 1. Name of Applicant. _-,� F i ref,N PLa20,4cc� ►� Address: 9 l-{� (K{?(?y Q f Telephoone:_. S�Y— 47 / 1�- 2. Owner of Property: <-- lte a L FL c�c Address: 1 � � . Telephone: L 3. Status of Applicant: Owner Contract Purchaser Lessee �1Other(explain): E­j&_--6 1 L_- CG'!--� 4. Job Location: Z 2 t55— c Cs— Parcel Id: Zoning Map# _ Parcel# 0 District(s): (TO BE FILLED IN BY THE BUILDING DEPARTMENT)- 4 / ) 5. Existing Use of Structure/Property J i 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): 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. S. Has a Special PermitNadance/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 N A-_ 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—X,,,- 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 # 963241 FEB 2 4 119% ;APPLICANT/CONTACT PERSON: AIYYDRESS/PRONE: t T1. fz� PROPERTY LOCATION: , 2 MAP p7 PARCEL: ZONE, THIS SECTION FOR-OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING F01RM EIT LF � Fee pairi Ruildin2 Permit Filled nut -Fee pniri Build n2 Plnmz Tnchified- t/- ��' Cal . THE FALLOWING 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 Conservati;nmmission Signature of Building or Date NOTE:lssuanoe of a zoning permit does not relieve an applioant's burden to oomply with all zoning requirements and obtain all required permits from the Board of Health. Conservation Commisslon, Department of Public), Works and other applioable permit granting authoritles.