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35-096 (11) r < n a z m O R A = g N C: r .= in Z L > Z PW rn _a I Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.— Alterations NORTHAMPTON, MASS. q130 19 Additions APPLICa ATION FOR PERMIT TO ALTER Repair Garage 1. Location 12 C 4A41z- ,AK)6� Lot No. 2. Owner's name iOA4 --k !/-L.LFy &A&tiYAddress'�- l��L S�F�1r ��N�2si 3. Builder's name '7E F Fkn 01.1 F Address `2 E15 KE HILL RD, 5 14-CL 8 U tiE Mass.Construction Supervisor's License No. ©4'3 CC, r7 Expiration Date IC-4. Addition o �kTrsN a�c�ssTe �A�R 5. Alteration 7- CA, P :`s 6. New Porch 7. Is existing building to be demolished? 8. Repair after the fire — 9. Garage No.of cars / Size 10. Method of heating CDV14 U,;" 11. Distance to lot lines FM.-u'! �S r. ` 4-4 -C-FT 51 bC— ���` 67(C-(6 12. Type of roof �J�{1�Li >tJ/nlCi�ES 13. Siding house 'x?sl 14. Estimated cost- l�j�d The undersigned certifies that the above statements are we to the best of his, her knowledge at>fi belief. S CCU/t+%� 3QvnEti �up.tu:s� Cv.c;w��i ?u O-� 5euwr— Signature of response le ap ! Remarks = �' 'LL . ` ! ` AW t�tiJ /�.•G � ci; 1ju v I` Q ia- � � o N M hi Vb s1 � � t �e � V � L 11 '1 9� °a ! CZa of Njart1J 1111-Ptoll 1 6 2 9 �/ :s4AChnsctt4 DEPARTMENT OP OP BUILDrNG INSPECTIONS ORE fAh'¢r',YQN f,„ 212 Main Street Municipal Building Northampton, Mass. 01060 WORZtER'S CO-iMTENSATION INSURANCE A M' AVIT I . DOME (li�nserlperml ttec) wnth a principal place Of bllS10eSSJf0SIdenCe at: F <C Ml L L S�-E-L13( 2►V �(phonei�) (&u-c,_vcity/qalrjz,p) M A, a 13"7© do hereby certify, under the pains and penalties of pegu y, that: ( ) I am an employer providing the following worker's compensation coverage for my , employees worming on this job: (Durance Company) (Policy Numb-c-r) (Expiration Date) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following wo FKer's compen-sation policies: (iian)c of Co imacCof) (I1'.5':: =nC Co III vi?OI1C: (l`�21I1C OI Cmat-mc 0C tL :`i.i�� �,OT1lD�..:1�'/r�t�� lll1„��� (�}.Dlr3ilOR Da(e) (Name of Contractor) (tnszu rice. Company1Pahcy Nuu1_bei) (Expjmbon Dale) (Name of Contractor) (Insur,uce Comoi'/Policy tvtumber) (Expiration Date) (Attach:ddi'�ccul pertaining to rill 0_'atraCton) (t*6 am a sole proprietor and have no one working fof ine. ( ) I am a home owner performing all the work myself. NOTE:please be acruc that whilo hoaxouum Abo amplay persons to do mai°�comcruuioa or repair'"Fk on a d.:: &of not more thm Ihruo units in which the homoouvcr rc-.idn oc oa the proun s:Pptj�thccto arc oot C,�000'idcrcd to be ctuploym under the vmdkc ;i c mpaasatico Act application by a homco w=for a liccnJC o<permit may evidence the legal ctatuc of An employor undorthe Work 'I C-=Pcmition Act I undcr aznd that a oopy of thin catcmcat a y bo forvvYUdod to tlw Department of I,x.+risfrial Aocid—&Ofiioo of I'nvrinco for tJ- coverage veciEcatica and that fail=to&omn oov':P b under socdca 25A of MOL 152 can lad to th.Y imposition of erimmw Pcnaltics 000sistiug o£n frne'of UP to S 1,500 00 and/or imp,-ao® of up to ono yrsr and cvi]pccxhia in the form of a Stop Work Order and n fim 0(5100.00 a day tgaiwt mc' Fcc&P-tw'-nl u-'o oaly Pcrmit Number j O 2 SS Maps : Lot# Si 1 Li rlPcrmittce 10. Do any signs ebst 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 colma to be filled is by the Banding Denartmeat Required Existing Proposed By Zoning Lot size 17 7 9,F4 5,C Frontage !vo FT ,t/o Setbacks z{" F No c'*Apwg - side L: /r l R: 3s L: R: No G G - rear 44. �T Building height F� Bldg Square footage F r. AA4E A/o C4A+tl44 %Open Space: (Lot area minus h7dg &Paved Parking) # of -Parking spaces 2 �/a csF.tNG� # of Loading Docks _ _- Fill: (volume--& location) 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. DATE: JD(/1Off APPLICANT's SIGNATURE 9 � NOTE: Issuance of a zoning g permit does not relieve an app cant's burl t ly zoning requirements and obtain all required permits from the Board of He h. C rvation Commission, Department of Publio Works and other appiioabla permit granting authorities. FILE # i Fi 1 e No. � k ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: I �a�/�G—'/L VA44- Y gAe r r�< <�2 uinr��t/�i f' Address: 43+ A • r"c,evt rf �i. f Axs+&:rCs', R4relephone: 4- i ZS,6 92J'D 2. Owner of Property:%10AJff'- 1;' V444AJ17-Ye Address: ¢34 AI)04,-rr7 sa,v—t5 A44tr-,F":,V Telephone: 443 9,,C6 g A-!r(9 A rN4) ; 4.13 2g3 3. Status of Applicant: '�Owner Contract Purchaser Lessee Other(explain): 4. Job Location: Z C.4K�LL¢itl� lCQk,,Q-cam Parcel Id: Zoning Map# Parcel# District(s): /� (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property L5«1r4C- f-�4 «.`/ REsc,0EAi:z-- 6. Description of Proposed UseN1/ork/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. 8. Has a Special Permit/Variance/Finding ever been issued for/on the cite? 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 ✓ 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#BP-1999-0465 APPLICANT/CONTACT PERSON Jeffrey Dome ADDRESS/PHONE 2 Fiske Mill Rd(413)625-9244 PROPERTY LOCATION 12 CAHILLANE TERR MAP 35 PARCEL 096 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildinp,Permit Filled out Fee Paid Type of Construction: L New Construction Z01 A7 1�1_ wl� Non Structural interior renovations / Addition to Existing Accessory Structure Building Plans Included: Owner/Occupant Statement or License# 3 sets of Plans/Plot Plan TH LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: 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 Se tic ADDroval Board of Health_ Well Water Potability Board of Health Rnh Cominyssi'on Signature o4rW4,0Z 1 Date Note Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning regm> +0 obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. Reference No: BP-1999-0465 Department: ................................... Building, Electrical & Mechanical Permits .......... ............................................................................. Fee Type: Receipt No'. Non structural interior renovations 111�1'('-1999-001267 ... ..................................................................................... ................ ..................... Paid By: Paid in Full On: Jeffrey Dome Thu Nov 05,1998 ......................................................................................... ...................................... Received By: Check No: Linda Lapointe 1653 ........................................................................ ................ ......................................DEPARTMENT'S COPY Amount: 540.00 --------------------------- DEPARTMI"Wl' FILE COPY 12 CAHILLANE TERR CITY OF NORTHAMPTON BUILDING PERMIT Owner's pulling their own permits or dealing with unregistered contractors for applicable work do not have access to Guaranty Fund(MGL 142A) Issued: Permit No: Inspector: Tracking No.: Fee: BP-1999-0465 $40.00 GIS Map Block: Lot: Address: Zonjn Use Group: Lot Size: 6912 35 096 001 12 CAHILLANE TERR SR 9975.24 Contractor: License Type: Insurance: Jeffrey Dome CSL Address: License No.: Insurance No.: 2 Fiske Mill Rd 043099 Liy_i State: Zip Code: Phone: Shelburne MA 01370 (413) 625-9244 Project No: Category of Work Const. Class: Cost Estimate: JS-1999-0801 Non structural interior renovati $10,000.00 Description of Work: REPLACE WINDOWS,FIXTURES,INSULATION,DRYWALL,&ROOF GeoTIVIS@ 1997 Des Lauriers&Associates, Inc. Signature: