35-137 D M
..h D
O Z
O R .ti i S
F
C' vt Z
> O
Z •� � �
� r Q
A
Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. • S r Alterations
NORTHAMPTON, MASS. -;aAn/ - g 19 '' Additions
% '
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location 2Z Lot No.
2. Owners name Zi `— llf'411-e tf Address ,5
3. Builder's name d ���i5 e !� c�t�- Address 4-1 S--7—
Mass.Construction Supervisor's License No. li.7 S U Expiration Date y— u
4. Addition
5. Alteration
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 VLvj.q
14. Estimated cost:- C1
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
Signature of responsible app,icant
Remarks
-
� � � � �IasaacE<asctfs
%L '
'
I' PARTMENT OF BUILDING INSPECTIONS
212 Main Street a Municipal Building '
O SJ,yi
Northampton, Mass. 01060
WORIKEWS COMPENSATION INSURANCE AFFIDAVIT
I, C
(licenser/pemvttee)
with a principal place of business/residence at:
Ll (phone#)
(st reeUcity/state/xip)
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)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the 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)
(aciarh additional shod if noes Lry to include inf« oa pertaiaing to all ooatradon)
(/am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that while homeowners who employ pazom to do mamtenaacq suction or repair work on a dweUkg of
not more than three units is which the homeowner resides or on the grounds appurteawt theatre am not generally 000sukrcd to be
employers under the work,ees oompaisatim Ad(GL152,ss 1(5)),application by a homeowner for a license or permit may evidence tho
legal slaw of an employer under the Worker's Compomatioa Act
I understand that a copy of this statement may be forwarded to the Depwtaxot of Indusuial Amdw&Office of Insauance for the
coverage verification and that failure to secure ooverago under s&-Uoa 25A of MGL 152 can lead to tho imposition of criminal penalties
comisting of a fine of up to$1,500.00 andlor impriso� of up to one year and civil penalties in the form of a Stop W mk order and a
film of 5104.00 a day against me.
For dgnctmrtal use Cray
j- Permit Number
Z y Niap# Lot#
Signature of Licaenseel ermittce I
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
LACK OF INFORMATION.
Thin colas= to be filled in
by the Building Department
l Required
Existing Proposed By Zoning
I Lot size
Frontage
Setbacks
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parkin-1l
# 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 knowledge.
DATE: f—Zg I� � APPLICANT's SIGNATURE
NOTE: Issuanoa of a zoning permit does not relieve an applican s burden to oomply With all
zoning requirements and obtain all required permits from the Board of Health, conservation
Commission, Department of Publio Works and other applicable permit granting authorities.
FILE #
JAN 2
9 1998
J
a._. j Fi 1 e No. 3
ZONING PERMIT APPLICATION (§10 . 2
PLEASE/ TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: Cali' C 1�� %rT -3/'"
Address: sT 16it Telephone:
1 Owner of Property: 41tA-�tQ-C9
Address:_ L/ 1zCj`)kI trey,c_1 JZ-KA Telephone: 59v-
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): /
4. Job Location: 3 L�✓e STz/ 0 � ' %T7�CJC __
Parcel Id: Zoning Map# Parcel# 137 District(s):
(TO BE FILLED IN BY THE BULLDING DEPARTMENT)
5, Existing Use of Structure/Property � ter'-4c C't _
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 Permit/Vadance/Finding ever been issued for/on the site?
NO DON'T KNOW— t/ 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 l/ 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)
i r r.
FILE
� A �
LIC NT/CO' TACT PERSON: � 5 /
�
PROPERTY LOCATION:
MAP ` � PARCEL:
THIS SECTION FOR-OFFICIAL USE ONLY:
PERNHT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM ITHIET) OUT
Fee Pnid
Fee Paid 2zjzll
r
New Cnnstrnrtinn
G �'..
THTiFOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION-
!�// Approved as presentedfbased 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 Commission
_L�z� ;? _A
Signature of Buildin Inspector Date
NOTE:lssuanoe of a zoning permit does not relieve an appiioant's burden to oompty with all
_ zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authoritles.
b
� 0
ti
CL
14 •..m•?
t Cam' W
Q' •� �t vp in R Oo
(�D r• �]
n `"' Fv O � rat I
�-�,
PD x _N
00 � ° a• C � o N ' b_
(/j v G ' sy f1, R
bd � � � g � 9ng• n e.
�-y r• m .7 C, r
\.J v C. O cn n ° r-
mo' d � & ° v �s a i° C
CD
Ul
c�
ao O 0
�
d 5 � 0 0 e
° do
c r(
z
cn
O �
CD y
0 0
00
ML
CG C cr
R C. p 0 C. CJ' "n
92 CD
v
71 7d 7� "�1 7d a
Ell-
-71 ❑ o �.
-o cr co rz °c �. c° c. :3 ' p'
° o an ao o ao ° °
CD
n tz o a
Cr1 o o u
n