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38B-008 (16) ?°4��°"• Cityof Northampton REQUIRED INSPECTIONS I. BUILDING DEPARTMENT 2. Structural Compongs and nents rrPlace* 3. Complete Building* No. 1506 Office of the Building Inspector Zoning Form No. 963448 Date 4/28/98 Fee$40.00 Check# 1474 Page, 38B Parcel 8 ,Zone GI Section 127 ❑ Yes © No BUI]LDINGPERIN/HT *Plumbing and Electrical Inspections required THIS CERTIFIES THAT Raymond Wischhof before Building Inspections has pennission to remodel interior for emplyee breakroom Inspection on Site—Foundations situated on 126 West St - Physical Plant Inspection of Plumbing—Rough provided that the Inspection of Plumbing—Finish p person accepting this permit shall in every respect confonn to the terms of the application on file in this office, and to the Gas Inspection provisions of the Statutes and the Ordinances relating to the Construction, Inspection of Wiring—Rough Maintenance and Inspection of Buildings in the City of Northampton. Any violation of any of the terns above noted is an immediate revocation Inspection of Wiring—Finish of this pennit.Expires six months from date of issuance,if not started. Building Inspection—Rough Note:A certificate of occupancy will be issued by this office upon return Insulation Inspection of this card signed by the Plumbing,Wiring and Building Inspectors. Building Inspection—Finish ** Install per Manufacturer's information: windows, vinyl siding,roofs and woodstoves Smoke Detectors(Fire Department) Other THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS LACE ON MISES Certificate of Occupancy Building Inspector 2 '1998FILE # 4 i 'v i U 1 APR 4 APPLICANT/CONTACT PERSON: '`" ADDRE$�TVQNE• ® ' PROPERTY LOCATION: Za � MAP PARCEL: ZONE_ THIS SECTION FOR-:OFFICIAL USE ONLY: PERNUT APPLICAf.TION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM Mjr,Fj) OUT Fee Pnid Rnilding Permit Filled nil Fee Paid - �-- Arreqqn — 13 Sets nfXllil�aflnt Plan T OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION- Approved P ICATION-Approved as presentedfbased on information presented ', Denied as presented: Special Permit and/or Site Plan Required undo : § PLANNING BOARD ZO �G 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: Pk'V # �terAvailability Sewer Availability W. 1107i.-C-1 Approval-Bd of Health,4 Well Water Potability-Bd Health n� Signature of Building Inspector Date NOTE:Issuanoe of a zoning permit does not relieve an applloant'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 ether applioable permit granting authorities. I I APR 2 ,4i�9 Fi 1 e No ly. i :ZONING PERMIT APPLICATION (§10 . 2 PLEASE TYPE OR PIUNT ALL INFORMATION 1. Name of Applicant: g o,,La � o 1'=-- Address: / '=--Address: Cj Telephone: S3 2. Owner of Property: An Address: Telephone: 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): C Q .y T iC-4 CT'o /e 4. Job Location: Parcel Id: Zoning Map#_<l Parcel# _ District(s):_ fly (TO BE FILLED IN BY THNG DEPARTMENT) 5. Existing Use of Structure/Property_ 0/%,-!::�G� 6. Description of Proposed UseMork/Project/Occupatibn: (Use additional sheets if necessary): rrC 2 PG d yam", r �r OCG ,�P a 6 An 7. Attached Plans: 4,-' _Sketch Plan Site Plan Engineered/Surveyed Plans Answers to the following 2 questions may be obtained by checking v4th the Building Dept or Planning Department Files. 8. Has a Special Permit/Variance/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 wetiaAds? 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) 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 colr= to be filled in by the Building Department Required Existing Proposed By Zoning Lot size Frontage Setbacks - front - side L: R: L: R: - rear Building height Bldg Square footage %Open Space: (Lot area minus bldg &paved parking) # of -Parking Spaces ht 6f 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. oll DATE: 'Z APPLICANT's SIGNATURE NOTE: lasuanoa of a zoning permit does not relieve an ajviSlicanto 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 applionble permit granting authorities. FILE # �O�Tt1AMP�Oy • � o e 2 4 i9° �` #l�ttntrr L asaxr4asrtta m DEPARTMENT O, BUILDING INSPECTIONS )4Iam Stre@t ' Municipal Building Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT (1icen- per tree) with a principal place of business/residence Vit: �i 4idy'�phone# ) ' �{ — 3 o2 -5- a (strr-t/c ty/statrhip) do hereby certify, under the pains and penalties of perjury, that: (o-ri am an employer providing the followitig 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) (Insuran(-- Copbpany/Policy Numbcr) (Expiration Date) (Name of Contractor) (Insw`anc,Colpauy/poiicy Number) (Expiration Date) a (Name of Conizactor) (Insurance Copan}./Polic�y Number) (Expiration Date) (Name of Contractor) (Insurance Co0lpany/Policy Number) (Expiration Date) (attach additionsl shoee if noocxury t4 me}ude iofoema.pert .i .g wall ooaanclon) ( ) X ani a sole proprietor and have no oneI working for me. ( ) I am a home owner performing all the avork myself NOTE:Please to awun that whilo homoowo=q yo employ Occrom to do maidenana,oomtrucdomor repair work on a dwelling of not wore than throe units is tabxh the bomoowacr wide s or oa thb grounds appurknud ihercto am not gcooeally ooaridcrod to be Vl etas under the wmifc oomP-4oa Act(GL152,=1(5)),#pplica6oa by a homcowncr for a Gecase or peemd shay evidcn=the Of an employee underthe Wocicoh C.ompeosatioa A.t r understand thea copy of thin cmtement may be forwarded tl?e Dtpertmoo1 of 1-h- id Aocidco&t oo of lnsuraaos for tla 00VmV verification and that fadurc to sw=cov=V=dcr=fioa25AofMGL 15Z caq lead to tbd inspoartion of criminal p=ddea 009 8cf&&c of UP to 51,500.00=&or iMM60=crA of tip to one year and civil pem,16cs in the form of a Stop Work Order and a bm 0(3100.00**y apinA tnc Por dcp=tm=sbd—only / Pcrmit Number Nfi P# Lot# Sj .: . aLicxmsee(Pcrmiticc T • X V_ I� Go T i ty r D Z pn £I r et O�I f� -� Ln z f j _ y Z ^ y n rn Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.S+'33 �� Alterations NORTHAMPTON, MASS. 19,? Additions APPLICATION FOR PERMIT TO ALTER Repair a i Garage 1. Location zQ tl, wz Jj�"— P T— Lot No. 2. Owner's name t /�f-� C o L 1"',L Address i 3. Builder's name A,j5'> A� Address/ Mass.Construction Supervisor's License No. 2-16 Expiration Date. 4. Addition 5. Alteration Alhi L4.> 1---Alt fOZ—a ?' fiHA2 �a l��Yc' O oG�it 6. New Porch 7. Is existing building to be demolished? j 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. 221 Signature of responsible app,tcant Remarks