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35-147 (4) .9 > O v C A• :s7 ty C>k a o cn O Z I A Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations, NORTHAMPTON, MASS.= '� 199 Additions APPLICATION FOR PERMIT TO ALTER Repair Garage 1. Location —ALP ti 4. _ f Lot No. 2. Owner's name n . Address SGl tit 3� 3. Builder's name Its �o� �C,y Address M Mass.Construc[ion Supervisor's License No. C �:) t73 83 ho Expiration Date 4. Addition 5. Alteration I U DIAU 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 cost•- 3 j o D ' The undersigned certifies that the above statements are we to the best of his, her knowledge and belief. Signature of responsible app,icant Remarks . -tttnarrT oQ o • 4 G97 3 � _ �aESACtjttErtiE DEPARTMENT OF BUILDING INSPECTIONS _......__212 Main Street ' Municipal Building Northampton, Mass. 01060 WORKER'S COMPENSATION INSIfRA.NCE AFFIDAVIT (liceusez/permi tree} with a principal place of business/residence at: �— a->Z- IJ �g3 �shF.t'jL A6 CbS.J—Al MAss .01 1;j (ph rei# 413�3t9 �/4 (st-c,--U ity/statr/zip) do hereby certify, under the pairs and penalties of penury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job- �ct'll Edda 4 13oIRe y (Insurance Company) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, �Vethe contractor r homeowner(circle one) and have hired the contractors Ested below wing worker's compen sation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Compar y/Poticy Number) (Expiradon Date) (Name of Contractor) (Lasuranc-- Compaay/Poticy Number) -- (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (aaath additional shoct if noccnuy to ineludo information pextaiaing to all correctors) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:ptcase be aware that wbilo homcownem woo employ pasom to do m kdc s m comauaion or repair work on a dwelling of not mote than throo units is which the homeowner midcs or on tbo g wads appurtenant than arc not ea-Ally 000sidcrcd to be employers under tba workcr'x oom;=natioa Act(GL152,ss 1(5))�application by a homeowner for a Goa=or pcYmd may evidence tho legal claws of an employer under the Workvea Compomation Ad. I understand that a copy of this statcmcat may be forwarded to tbo Dcparuwcd of Industrial Aodd x&offloo of Iaxrr.noa for rho coverage vaifieation and that failure to aceure coverago under suction 25A of MGL 152 can toad to the ia>posibon of criminal pedaloes oom istiog of a-fine of up to S1,500.00 and/or of up to om yw s:al civil pcmYtia in the form of a Stop Work Order and a fino ofS100.00 a day agninstrua Signed this d�Y of_D� `' q 1997 For•dalusoonty Permit Number X,,,-. Cp --g rd-p- Map# Lot# -— Siguat ue of LiamseeRerwittee Concrete Slabs • Patios•Sidewalks • Block Buildings• Stonework• Plastering• Fireplaces a Specialty•Authentic Restorations RICHARD E. STAELENS MASON CONTRACTOR Tel. 369-4643 Ashfield Road Conway. Mass. 01341 I� Ic:hAI- E STpe)F�'S 9.3 /i L r I(, 9 y - . C0 k/ wr�y MA5-5, o13g1 R a y 2 Ph e N`r R e-t )kj 0 `( (0 1 O.7 vC-T) ° ' J aPe-Y v i, Sor LIG.EP<SE 5 h n J—k- 0 0 ovr ti. TO hisy,A, V-Se �u0 i� a, a� P�jy�r GorcreTei 10�.aX .� Sltn �l � n� vP GCtAe �1H5 gro STc�r—GO ouTsl� e O-C VT5Y1�� S � � I1 8 dR'Gk f7R6AA 61PO4e T"6 '`o P, ci,T �)wA� W4)1 Sr-rfr) a.v 4 ,S7^ t/ 6U" - cvi ZP 36 u,id e- r-tv ��A�e , �,�e PL�vo� Sh 41e 12 4" e-- 12'' RAtdf'd 7�ICAr7-H 1,,i7 h Q1- �e5' - -f, 7-0 P- E ; (3 d Y S h fll ,8e 0-E REA 'Fi"e. ,BRIE-Xs 5-4n 11 8e, ReC( 1J,9,i-)� -5 &1�`�'h 8 1aC,SM�-e /� 0A.,-r-e.,.-:7 S h+ /LeD d A"r 4�0 0- 4e,116/4, F1-ce-5 £'� r E j'YcI �,va e- S?I � g� 231CZ� ,c.w 5ja.9, w��h f e,�r.1 z--o- -j COA&A;t- 667-�VeC.v, PAcJ< f'�l! i 4// A e, o"F. CC A-IL e tiT ,�1�'s. 49 4'f a06)a- 9' 4/or Y 1'4 1,5 �-vr Th-e _ 4 SOaC a e � 11/2 Interest Charge After 30 days In the event this account is unpaid and it becomes necessary to engage an attorney to represent the creditor in the collection of said account the debtor will be obligated to pay a reasonable attorneys fee together with any other costs of collection. Ak oil Fk a o L- U e-, ' � I s� 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 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 CR OF INFORMATION. This C01—M to be filled in by the Building Department Required 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 &paged parki_ngi # of Parking Spaces # (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 kno ledge. DATE•% APPLICANT's SI'GNATU E: Innuanoe f a zoning " e es not relieve applid s burden to oompty with ail zoning requirements and obt all require rota the oard of Health, Conservation Commission, Department of PubI 0 Works and other applicable permit granting authorities. FILE # File No. 9&3e2b s. ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: /� /� Address: /� (.� C�;iC T Telephone: 2. Owner of Property: t 'f' W� l�,Vl.ti.� t,�l law Address: u(yn Telephone:_ j1 b 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): u 4. Job Location: Parcel Id: Zoning Map#_ Parcel# t District(s):_ ` ) (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5, Existing Use of Structure/Property 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. 8. Has a Special Permit/Vadance/Finding every 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 le." YES IF YES: enter Book Page and/or Document# 9, Does the site contain a brook, body of water or wetlands? NO_e--,,*, 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 # DEC 41997 ? _0 APPLICANT/CONTACT PERSON: PIIES511`HONE: PROPERTY LOCATION: `C AO C*,.,. ,au MAP 03,57 PARCEL: ZONE THIS SECTION FOR-OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM MLED 0111 Fee Paid BuilfjinZ Permit Filled nut Type of Consinirtion- Remndeling Interior 4 Addition tnVyisting T OLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION- d 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 Conservatio Z"n"sion 1.,7-171/Y-2 Signa e o or Date NOTE: Issuanoe a zoning permit does not relieve an applioant's burden to oompty with all zoning requirements and obtain ail required permits from the Board of Health, Conservation Commission. 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