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� Zoning
�Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. S^,1131 Alterations
NORTHAMPTON, MASS. 'ftpeil 1925—? Additions
APPLICATION FOR PERMIT TO ALTER Repair
f r
Garage
1. Location Lot(No.
2. Owner's name �(V,\' Address { ► kJS , crk, �a
3. Builder's name (4t Address w 5
Mass.Construction Supervisor's License No. 1 S ac I Expiration Date a
4. Addition
5. Alteration C-P-YQ, q-, LAn CZ t '+-Ita qiC QZQh,
6. New Porch A
7. Is existing building to be demolished? �o
8. Repair after the fire
9. Garage (� No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof h�r`C eS
13. Siding house
14. Estimated cost:-
10 X00 The undersigned certifies that the above statements are we to the best of his, her
' knowledge and belief.
Signature o responsible appicant
Remarks
W. Marek & Son .�.
GENERAL CONTRACTOR/BUILDER �`
HOME IMPROV.LIC. 104413 CONST.SUPERVISOR LIC.004151
BOX 110 SHAW ROAD GOSHEN, MASSACHUSETTS 01032
---- (413)268-7109•(413)529.0003
APR 1 51998
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AR 1
DEPARTMENT CF BUILDrXG INSPE(.71ONS
212 Main St ee et ' Municipal BuIding Y
Northar aI Eton, Mass. 0106(11
WORIaWS COMPENSA'fTON INSURANCE AFF DAVrr
(Iicen��°lpermitttre)
with a principal place of business/residenc at:
_(phone#) � ?}�q
(Stre 'r.ay/stale/rip)
do hereby certify, under the pains and ppa tl tries of pegury, that
X) I am an employer providing the fo3lov-J..ig worker's compe:rsation coverage for my
employees working on this job:
l T1 v-_ 106 4:�
(Insurance Company) (Policy Number) (Expiration Date)
QQ X am a sole proprietor, general contra;Lx or homeowner(,;iAcle one) and have hired
the contractors listed below who have the fallowing worker's compeimtion policies:
-Lv-.k4 -9 6'&qQ'�O qlllqq
(Name of Contracto � (Insurance C n upany/Po'cy Number;' (1* tion Date)
(Name of Con ctor) (Insurance C:)i apany/PoUcy Number', iration Dale)
(blame of Contractor) (Insurance C:)i apans/Po1a'cy Nwnbez) (Expiration Date)
(Name of Contractor) (Insurance C:)r apauy/Policy Number) (Expiration Date)
(attach-kHocral sheet ifneecu q to imchrde wfi n, x oa pettu xu q to&U omk%cwn)
( ) I am a sole proprietor and have no on:,- work mg for me.
( ) I am a dome owner performing all the•b Cork myself.
f
NOTE:Please bo amts that wbiio homecivam who satplay;:c==to do maiatcaaracq o=;hudfoa or rcpaawork on a dweUing of
not`nO"than duos Uaits is which the homoowwr ret es or on t as grouns appurtenant therdo n m not geaaally 000side and to be
employers vadcr the worka'a oompossatlon Act(GL152,ss!(S)),ry+plication by a honieownir fo,r a ticetssG or permit may ovideaue the
legal slxtua of—arwlayw uudortbe Wodcoes compemation A.:.
I understiad that a oopy of this mtecawt rmay be faw.,W t,t ao Deput=w of Indudrial 1I ocideatd Offioo of Imv+anoo for tho
coverage vtrift00=sad that faflttre to secure coverage under se zu on 25A of M(3L 152 can Iml to tbd imposition of triminat pea mes
ooasistmg of a-fix tafup to S1,500.00 and ar hnNi,�of ui .G one year and dvl pmaNcs is i the facm of It Skip Work Order and a
fitle of 5100.00 a.day against rue
Foe depam.ie�sr use oaiy .
Permit bI'umber
Lot#
Signature of LicI.seeJI'cctnxittce 'ti=e
.
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 col— to be filled in
by the Building Department
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
&paged parking)
# of Parking spaces
frof Loading Docks
Fill:
-(volume--& location)
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
DATE: APPLICANT's SIGNATURE G%
NOTE: Issuanaa of at zoning permit does not relieve an applicant's burden to ao ply witfa-all
zoning requirements and obtain all required permits from the Board of Health. Conservtstion
Commisslon. Department of Public Works and other applicable permit granting authorities.
FILE #
r, File No. C 1
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
W c ��-� `�" R
1. Name of Applicant: -" ` " � � r`I�
Address: 9q J Y LW Gzr' h1C^ Telephone:
2. Owner of Property:
Address: btu"�"S" )r° Telephone: ��� 6;)00
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: '--;)/L-2
Parcel Id: Zoning Map#�_ Parcel# District(s): Z�,�.
(TO BE FILLED IN BY THE BUILDING DEPARTMENT
5, Existing Use of Structure/Property ' -ty' s -
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
7. Attached Plans: Sketch Plan x 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/Variance/Finding ever been issued for/on the site?
NO A 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 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 T 0"
APR L 4 1998 _
96, 3401
APPLICANT/CONTACT PERSON: d M/&/),*
a :ADDRESS/PHONE:� n 3
PROPERTY LOCATION: o�-
MAP PARCEL: ZONE
THIS SECTION FMOFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
lRitilding Permit Filled nut
a
TFVtOLLOWING 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
S
19 3
Signature of Building Inspector ate
NOTE:Issuance of at zoning permit does not relieve an applicant's burden to comply with all
zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
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