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Zoning
Miscellaneous Additions, Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
L Location r p S c ti: r- Lot No.
2. Owner's name Ca t, �, c c, + ;n_,A; �rte.- Address
3. Builder's name -6 1Z�A-11- J. C lIf e r i e it, Address J l I) ,, A
Mass.Construction Supervisor's License No. U.3 q 1 ,575"1 Expiration Date
4. Addition
5. Alteration 14 c�� /i�t� ��� I�e�k ��, �k+ 5 �� �� v c.: CJL K- c
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
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cosL-
The undersigned certifies that the above statements are true to the best of his.
knowledge and belief.
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TJTJ signalurt of resp nsible app icant
Remarks��5 i S e �n to f� C ��„ �„ a �+� II
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J DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
W0 RICE R'S CoMTENSATION MSUxA-NCE AFFMA. xT
',(li cen_scrJpf;rmi flee)
",vith a principal place of buSMCeSs/resideace at:
(� _�� �� �� t:,.>~„t�� %�u- t�ta•��(Phone#) �.�� � t�3.� �
do hereby certify, under the pains and penalties of perjury, that:
O I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(IIlSUiancc Corals uyj (Policy Number) — ---- (l xpiravon Date)
( I am a sole proprietor general contractor or homeowner (circle one) and have hired
the contractors s elow who have the following worker's compensation policies:
(Name of Contractor) (Insu=oc Company/Policy NumbcT) (Expiration Date)
(Name of Contractor) (insurance Company/Pohov Number) (Expiration Date)
(Name of Contractor) (Lug trance Com iany/Polic,Number) (Expiration Date)
(Name of Contractor) (jv=ancc Company/Policy Nunllr._r) (Expiration Date)
(atladi additioail s?s.-ct if to all eoatracton)
( I am a sole proprietor and have no one worErig for me.
( ) I am a home owner performing all the work myself.
11077:pI� c b atir^c that ci p lcy pc,zoas to d ma P t �C�w won a icpau woii,cn.C�t!ls:�c'
not nice than time units in%%incd tla f co;tiv r tt id or cc the uxuxls apPutcnufl the arc DO(ga�cr'lly axi id ul to b
employers undcr the Ad by n homcoava for a(crnsc a perunit nl^y c`i&�111:
legal ctatua of en employer under tiro Wor{o L Cony-' s- tioa Act
I under:t nd ttut a copy of this e2itemca:auy bs fc�—dnd t4 elo D A—tmcnt of l,—I Iiel Aradt�Olio''f L' for[he
covcagc vrrificatioc and that Lilurc to tcc urc covtr tuidct sot; ioa 25A of htOl,152 can lad to the'inipositioa of crim nal pcnalt ca
coazistmg of rt frne'of up to S 1,500.00 ar0or mprisoamer>i of up to ooc year and a'til panities is the form of a Stop Work order and a
firm oCS100.00 a day ipinst ar_
FoC&Putaylka1 u•o ooly
\ PCrmit 1`umbeT
Lot#
Sipnahure of Uccasccl crmittcc
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10 Do any signs exist on the property? YES NO X
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 column to be filled in
by the building Department
(Required
Existing Proposed By Zoning
I Lot size /U� L, " s�. ��✓O
Frontage
Setbacks - front
- side L: ,3 y' R: 7 L: 3 c' R:
- rear 4/ 0 ' 3 V
Building height
Bldg Square footage �J 11 � 10
%Open Space: O�
(Lot area minus bldg 1 Q U 7 5 e 20
&Ps-ved Park%^)
# of Parking Spaces j
# of Loading Docks
Fill:
-(volume -& location) —
13 . Certification: I hereby certify that the information contained herein
(f is true and accurate to the best of my knowledge.
DATE: ly_ 3 — cac APPLICANT's SIGNATURE
NOTE: tssuanoe of a zoning permit does not relieve an applioan burden to domply wlth 4m
zoning requirements and obtain all required permits from the Board of Henith, Conserv+,atior
Commisslon, Department of Public Works and other applicable permit granting authorities.
FILE #
F
APR 3 20M I Fi 1 e No / C/�O 7 t
-ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 1C t ��� (cA v'v e
Address: � 5 s.,A l &t—OALv Telephone: S `1 - 0 3 3 3
1 Owner of Property: G w C z N hone:L.rc
S Qy �7 9
Address: F I !)re w ..5c• ��r Telephone:
3. Status of Applicant: Owner _Contract Purchaser Lessee
Other(explain):
4. Job Location: ," � � ,- e-w 5 L ry D r
Parcel Id: Zoning Map# Parcel#_ 76 __ District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
S. Existing Use of Structure/Property L Q K,
6. Description of Proposed U e/Work/Project/OGcu bon: (Use additional sheets if necessary):
qA p ' .
/1'V l �CXJY l 1 /C,' �J Y✓ �.X{'lam ) t d�1� J r�ILJt� 1 tl�`� [ C�V t! 4 -9 /^ l�C� �. 4K' t L(t I�.
tit".k- `ti, a t'f�2 5 C i^ t' ��.2-ci e� (u o �,4 - T C �i c,vim. �t 3 1 jT: c� 4 wu�. Oa;.✓' C
i
tx;; V_ t1 5 n t=k.v s
7. Attached Plans: �C 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 Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW l'C 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#BP-2000-0842
APPLICANT/CONTACT PERSON Robert Carrier Jr
ADDRESS/PHONE 16 David St (413)527-0333
PROPERTY LOCATION 83 DREWSEN DR
MAP 35 PARCEL 098 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid /-/22—/
Typeof Construction: CONSTRUCT 12 X 12 DECK
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 059154
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presentedibased 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
�y 1-4t,St;Z. Finding Required under: §-�r w/ZONING BOARD OF APPEALS e7Q�1`
'Pal {e ^, dam
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 Board of Health — Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Signature of Building O ficial Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission, Department
of public works and other applicable permit granting authorities.