43-079 (4) �r4, City of Northampton REQUIRED INSPECTIONS
;`;
BUILDING DEPARTMENT:t 1. Footingsand Walls
2. Stn�taalComponents inPlace*
3. Complete Building*
No. 1487 Office of the Building Inspector
Zoning Fonn No. 963433 Date 4/22/98 Fee $20.00 Check# 2053
Page, 43 Parcel 79 ,Zone SR Sects in 127 ❑ Yes UJ No
BUILDING PE \/ IT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THATiWestern Mass Siding & Roofing before Building Inspections
has permission to install replacement windows Inspection on Site—Foundations
situated on 41 Dunphy Dr - Karen Klekotka Inspection of Plumbing—Rough
provided that the person accepting this permit shall in everespect Inspection of Plumbing—Finish
every
conform to the terms of the application on file in this office,and to the Gas Inspection
provisionsof the Statutes and theOrdinancr,s relating to theConstruction, Inspection of Wiring—Rough
Maintenance and Inspection of Buildings in the City of Northampton.
Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring—Finish
ofthispetmit.Expires six months from date ofissttance,ifnot started. Bulking 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 tk Y ;74-qi< z,
*4 Install per Manufacturer's information: windows,vinyl siding,roofs Smoke Detectors(Fire Department)
and woodstoves
F .f,,:. Other
THIS CARD MUST,: I PI/A, I) k CONSPICUOUS PLACE ON T PPREMISES
Certificate of Occupancy Y _� '
Building Inspector
-..
FILE ! 96 ) -r33 PYr
APR 2 ; 1998 •
APPLICANT/CONTACT PERSON:CC)e4t )/rd%
tda
ADDRESS/PHONE: P 3eArbt 51(-: tnTri
PROPERTY,/ OCATION: ` / �G/1� �t.� LL,
P
�~
PARCEL:
THIS SECTION FORAFFHCIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
7f1NTNG FORM FiT INT) OTTT
Fee Paid
Building Permit Filled nut
Fee Paid O.ST Sae-
Type of Conctruetinn•
New Cnnctrurtinn
Remodeling Interior
Addition to Vicki-jog
Arreccnry Structure
Building Plant Tnrluded-
. , S • . a s /
i Setc of Planc 1 Plat Plan
THE F�ILLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
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-Ed of Health Well Water Potability-Rd Health
_Pe ro ./y/Z-4
sgpatlo om
Signature of Building for 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.
1 1998 /
File No. 963V33
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: ♦ e p / • •
Address: 63 F msr S1- C,rnQ-hlrl//ra 4//<+ ✓ Telephone:1CZ
tc r2. 7
2 Owner of Property: K4 r en vl ( •C L ''
io f
Address: cif OE r acf pitt Or Telephone: ,stG-6PLIC/
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): `n
4. Job Location: 9l annld; y Or
Parcel Id: Zoning Map# r ) Parcel# 2 /p
District(s): .57
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5 Existing Use of Structure/Propertyse
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
'Ftio G.P/J/r w ' U m
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 PermitNariance/Finding ever been issued for/on the site?
NO DONT 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)
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.
Shia cob= to be filled in
by the Hailding 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
tip=ved parking)
# of Parking Spaces
it of Loading Docks
Fill:
{volume-& location)
13 . Certification: I hereby certify that the information contain/: • erein
4 is true`(and accurate to the best of my knowled
DATE: - 7��1/C/e' APPLICANT'S SIGNATURE / jf7/li/�/
NOTE; Issuano of a zoning permit does not relieve an i ,plioanta burden o comply with all
zoning requirements and obtain all required permits front the Board of Health. Conservation
Commission. Department of Public Works and other applicable permit granting authorities.
FILE
Istbsee
,,, s1*,,, (!iifj of Northampton -Narat
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— Y .Ira,•
.ssarnsetts — *I
ev
`nI'iDEPARTMENTOP BUILDING INSPECTIONS �'" _ -
212 Maim Street a Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFP1DAVIT X
Qice sef/pennitttc)
with a principal plarP of business/residence at:
) Ea--5.410.-17
.:K' Si" pi'vn ill (phone) £2 s . '�'kc -..J � 7
1 (snratcity/staufnp)
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:
(Insuranr'e Compam) (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) (Expiradon Date)
._.... (Name of Contractor) (Insurance Company/Policy Number) (Expiradoa Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
((Sah amidmal ebece einem:Lary m ariu4c information pertaining to all Edon)
(t/am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself
Noes:pts be aware that xhito Ymcowun vele°employ pawnl m de tact,crawveim°r repair bait on a dwelling of
not mat than three worts inevbichthe homeuuaarerdea tar m the grauods eppurtemntlbtM are we gmenity cemdved to be
esploye.a nodcrtent.kers xrq,enu situ Act(GLI$2.ai(5)),application by a bancowute fora Ikon=ccpemn may .i3,me the
legsi viable elan employer uader,ha Work&.Cmyro,u(ion Act
I n_._ . .that a copy of this gateman'nay bo(pwwdad to the Ucposmnmt ofIner*ial Amdedf Ofloe of lacono=For ear
cwmragemifieetim cod that fub¢c to sea=coverage urt?berm 2SA&MOL 152 as ks4toffia iSWn nett ufbreetal pwttere
Demisting nit Ewe atop to 51,500.00 arrNor mrprban °fey to ace ray bad civil panties in the farm of a Stop Work Order and.
fax Of 3100.00e.day against mc.
For dq,vemtr rrae only
pt Nut
2vta Lot#
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Slgnatore of Lionsec/Pe Wee Nate
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Zoning
Miscellaneous Additions, Repairs.Alterations,etc. Tel.No. Alterations
..761Z2-4 NORTHAMPTON, MASS, ll fl i9' Additions
ftelH APPLICATION FOR PERMIT TO ALTER Repair
f� y Garage
„' v
I. Location Li/ mP t/ Lot No.
2. Owners name K aIPvl t4 (£katkG Address 4 , Oa✓miahr i*' Fforr4,ce
3. Builder's name CO r-
+5 ern (/Iess Sidi?,_4-1.' Roe I;y F Address L3 l osT -r-A447 C a tot z re 07 �o
Mass.Construction Supervisor's License No. 0 3 ti(.4 6 Expiration Date I( 7/
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 kP fl(c c -e al-senT k
- //titt k)5
14. Estimated cost) b�i e Zi
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Or"�i.--a-i�t, X70 /Iso//y(
Signature of responsiblei,
appimm
Remarks