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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. Aug q 19?z Additions
APPLICATION FOR PERMIT TO ALTER Repair
q Garage
1. Location ( 4tJFc 7— Lot No.
2. Owner's name FAn �i �c11G Address TU2 I/ .+PCB
3. Builder's name E�Z Co 6e'?- �n Address tL R-e eal S' T"
Mass.Construction Supervisor's License No. D Expiration Date ld— 26,9(n
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 i✓ — l2,rte�l7 ��' 0 —T
14. Estimated cost:- �de--9
The undersigned certifies that the above statements are true to the best of his, her
knowledgbelief.
Signature of responsible app,icanl
Remarks
r
Boo 9a Crz Ir�x�lj�ntan
a e `
AUG 4199+ �iasvrtchnsrlla
m D9PAR7MENT OF BUILDWG INSPECTIONS
t
)Main Street Street Municipal Building
Northampton, Macs. 01060
WORZCER'S COMPENSATION INSURANCE Ali=AVIT
(Li 0Ms�/peruli ttce)
with a principal place. of btusness/residence at:
(phooe")
(51C:CV6 h'/statCha P)
do hereby cerdfy, under the pains and penalties of perjury, il]3i:
( ) I am an employer providing die following \vor�er's compensation coverage for rn�,
employees woridog on this job.
(Lnsu.rance 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) QLnsu-anc�--Corupany/Pobcy Number) (Expimeon Date)
(Name of Contractor) (Es C–z CompanyRoky Number) (Ea-pira6on Dzte)
(Name of Conn-actor) (Losuranc� Company/Policy Numbu) ( -xpiratioo Datc)
(Name of Contractor) (Insw-anc-- Compaay/Poky Number) (E)Tiration Date)
(r d s.eh zdditiomJ rhos if nooe-uy to i, de pert-_iaiag W"0o trae vn)
(Vf/l/am a sole proprietor and have no one working for me.
( ) I am a-home owner performing all the work myself.
NOTE_plmsc be awarc tbsa whilo homcownen wbo employ persona to do—i,e., Dec cowbvcLioa-or rrpat v`ork on a d--LUng of
not moce t1•^tbroo unit+is w6icfi the bomoawn raid=or ea the gouods Vptrrtensnt tbacto ere ooe grncr911y ooasibcrcd to bo
cmploya-a under tba v orkc aempcas4ca Act(GL152,,c 1(5)�application by a bomcow=for a licco3c a permit nosy evidence the
legal etahsa of as employx uadcrtbo Wor4cda Compomatioa Ad.'
I understand that a copy of this mt—t may be forwarded to tba Depart=cd of L5&L tj d Accidcn Of —of l=urvooe foe db
eovczxgc vcriGcsiioa and that failure to s,==covcntV coda socdoa 25A of MoL 152 can Ic d to tbd i rioa of csimiasl pcnaiti=
comisrma or a Sax brup to s 1,5oo.lio aallor impr 6oamrnt of up to ooc y=and civil p®ltia in the foam of a Stop Work Ordcr and a
find ors 100.00 a dry agaiwt mc.
Signed this `� day of y �1T 1997 For ooty
Permit Number
Maps Lot 9
Signature of Lio=n50lPermid-
t �
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.
This coltz= 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
' &paved parking)
of 'Parking spaces
of Loading Docks
Fill:
vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: APPLICANT'S SIGNATURE
NOTE: Issuance of a zoning permit does not relieve an applioanYs burden to comply witli,Apll
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
FILE #
A�)G 4 199(
File No.
ZO NG PERMIT APPLICATION (§10 . 2)
PLF.21 SE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 25�)D (�PVW6-5-7- c`1 Yz
Address: L( 4cl S POV� Telephone:
2. Owner of Property
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: j �Gf
Parcel Id: Zoning Map# Parcel# o?&F District(s): J
(TO BE FILLED IN BY THE BUILDING DE.PARTMENT)
5. Existing Use of Structure/Property GY!r�t-tom
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 PermitAlariance/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 #
9E ?G25 3
s AUUG 41997
APPLICANT%C NTACT PERSO
ADDgRE, NE:
PROPERTY LOCATION:
MAP ` ,,g PARCEL: ZONE
THIS SECTION FOR..OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZQNTNC�FORM Fn.T,FD OUT
Fee PAid
Bidldin2 Permit Filled nnt
ca —
New Cnn.,Qtrnrfinn
�x,
Addition to Ex sting
t
T LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION'
Wroved as presented/based on information presented
Denied as p resented:
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 Conserva ' Com i ' n
J
Signature of Building ector Date
NOTE:Issuance of a zoning permit does not relieve an applioant's burden to oomply with all
zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applicable permit granting authoritles.
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