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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
a NORTHAMPTON, MASS. q Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location t Lot No.
2. Owner's name Address P44 /.
3. Builder's name_ cs �� Address
Mass.Construction Supervisor's License No. °cJ 6 Il Expiration Date St'
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
14. Estimated cost-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
signature of responsible appicant
Remarks
QTtt^}fpT D — ;
8 �, 1 ( 1997 ^„� Cr�i-� �f fax#ljant�tnrr
�asanchnsrttrr
^^' DEPT OF P,
m ¢4T' _R TM DEPARTMENT OF BUILDWG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AT,MAVIT
!' (li�ns�Jpermittec}
with a principal place of business/residence at:
GL (phone#) f�y �
(strticity/ trjap)
do hereby certify, under the pains and penalties of perj'uuy, Lh?-,.
W I am an employer providing the f6llo«211g v.,or'r er's compensation cove age for my
employees worl;7ng on this job:
"/0 , �U_ - 6 ,
ez: mpaay) (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) (Expira6on Date)
(Name of Contractor) (1nsi=c_- Company/Policy Number) (Expiration Dale)
(Name of Contractor) Qnsuran(_— Company/Policy Nuinbe_r) (Expiration Dale)
(Name of Contractor) ansuranc__ Compaay/Policy Number) (Expiration Date)
(attach aGditioml shat ifnoo=u to include iaf"-r too P�_t .o to all oodradon)
( ) I am a sole proprietor and have no one worEng for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aaruc that vehi to homcowD=wbo®ploy pawn:to do ma iDlcna_=_,coa5nrc6oa or repair work on a dw cll of
not more thsn thrto undi is wfnclt the bomeowDCr r=den or on the gouDdr xppurteau3 tbereto art Dot&cD=iiy ooasidcrcd to be
employers under tbo wockcr's,oa pcmziioa Act(GL152,=1(5)),applii:moo by n homcow=for a liana cc permit may cvidcnoe the
legal rubm of an employee under the Wo&-ce L Compcoaatioa Ae(_
I uadcstaad that z copy ofthia mot®ryt may bo forwv rd<d to tbo Dcp�oflndru;rirl Acadca&Ofiioo of I w.'Doo for d.
covcaa verification and that failure to too=covcnTo tmdcr soctioa 23A of MOL 152 can Ind to tho'imposition of aiminzl patnlbcs
ooaystma of a fine of up to S1,500.00 and/or impriso®cat of up to one year and civil pcwd6a in the foam of a Slop Work Order and a
fine of:S 100.00 a day ag ainst me
Sign this / _day of 1997 For dc¢artawnw use oaty J
r
Pcrmit Number
•� ' '�.^P ' ' � Map;l Lot#
Signature of LiocaseeJPcrmi
• t
10. Do any signs exist on the property? YES NO t
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:
I1. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This columm to be filled im
by the Building Department
I 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
&paved parking)
# of 'Parking spaces
f %f Loading Docks
Fill:
4 voi-time--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
_1
DATE: ��- ! / � ;� APPLICANT's SIGNATURE t-
NOTE: leauenoa of a zoning permit does not relieve an applia4dnVe bur en to oompfy with''all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioabla permit granting authorities.
FILE #
j
1 P97
DEPT OF gM, !' aw�(7 ►
rs File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: /` A.-\- V-' / 1 fA-
Address: yG�4 S ► . n, s `t v�,e- Telephone: S 6
2. Owner of Property:
Address: e V t9 dy Telephone:
3. Status of Applicant: Owner Contract Purchaser i.-- Lessee
Other(explain): � p
4. Job Location: P�S V Z �cx.e-(,_ N
Parcel Id: Zoning Map# J Parcel# 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 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 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 # 5-q
.A1„ 1107
APPLICA , T/ ONTACT PERSON: 61 3 2 5'
OElT OF suli P-*H NE: 0
PROPERTY LOCATION: 6&y.
-��
MAP _ PARCEL: -7 ZONE_
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Fee PAid
Rnilding Permit MUM ut
Fee Pqifi M y
New Constriirtinn
Addition to Eyisting
T _ LLOWING ACTION HAS BEEN TAKEN ON THIS APFLICATIOM
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 Conservation mission
Signature of Building Insp r Date
NOTE:Issuance of a zoning permit does not relieve an applicant's burden to comply 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.
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