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Zoning
Miscellaneous Additions, Repairs, Alterations, etc. Tel. No. Alterations
% NORTHAMPTON, MASS.
k;:i4 .:,; 1 9 Additions
' APPLICATION FOR PERMIT TO ALTER Repair
e r-
'' Garage
1. Location (G t_! 00,'10 ✓1 v& l ' Lot No.
2. Owner's name g '‘) l M // Ik� b + Address M o,1 i�
3. Builder's name COM GXvt"1lccv1 Address I4 i AI et-)
Mass. Construction Supervisor's License No. C) I f0/5S Expiration Date J - 9 g
4. • n
5. on 1 R7 1
trt`oe Atr/c`1('(C3 -1 S C,� , Or�wt , i 1
6. New orch
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:
/5
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
^4r cJ
Signature of responsible appicant
Remarks 1`lf11( ‘`15 01C C'5 1 0-)(;c-,\ ki-ui IQ i ,7 9
oltA 1 p�, 4.
9�� � Z 7 f IYZ setts fan _ it 441 rl� 2 I J � j ` :a assachnsrtts _.v_.__
�'W __ - DEPARTMENT OF BUILDITjG INSPECTIONS =_`
212 Main Street • Municipal Building '
o
Northampton, Mass. 01060 ,~ um
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
L J ttbn GL 5 0,,,,‘414 pi
(licens,e ipermittee)
with a principal place of business/residence at:
A Q vm Ig1-1 Of . L14CI MA (phone #)(i/t3) 5 - 5.).3
(street/city/states CAD
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:
(Insurance Company) (Policy Number) (Expiration Date) .
'1' I am sole prop general contractor or homeowner (circle one) and have hired
the cont Blow who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance CompanyiPoLicy Number) (Expiration Date)
(Name of Contractor) (Insurance CompanyiPolicy Ntunber) (Expiration Date)
(Name of Contractor) (Insurance Company /Policy Number) (Expiration Date)
(attach additional she ifneccassry to Meal c information pataioing to all contractors)
() I am a sole proprietor and have no one work -Mg for me. iF4'•+11S - Par r SL,P •
( ) I am a home owner performing all the work myself.
NOTE: please be aware that while homeowners who employ pawns to do maistmance, consuuctioo or repair work on a dwelling of
not more than throe units in which the homeowner resides or oo the grounds appurtenant thereto are not generally comidcrrd to be
employers under the worker's compensation Act (GL152,s3 1(5)), application by a homeowner for a license or permit may evidence the
legal status of an employer under the Worker's Compensation Act.
I understand that a copy of this a:atcmcai may bo forwarded to the Departoscrd of Industrial Atcidots' Offioo of Io uraoco for the
coverage veriftcstioa and that failure to secure coverage under section 25A of MUL 152 can lead to the imposition of criminal penal ties
consisting of a fine of up to S1,300.00 and/or imprison of up to one year and civil penalties in the form of a Stop Work Order and a
fine of 5100.00 a hay against me. Q
Signed this )1 day of '1 , 1991 For departmental use only
Permit Number
tre-a,A- Map# _ , Lot #
Signature of LicenseefPermittee / i-
10. Do any signs exist on the property? YES NO Gfe4
IF YES, describe size, type and location: • 1 I n I‘ 1.* c '
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.
c 1
This eo�
■ --Fx by the filled
C.� the Eai2.a
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- 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:
voI- time - -& location)
•
13. Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
y
DATE: q — -1 APPLICANT 's SIGNATURE v
t" NOTE: Issuance of a zoning permit does not relieve an a
9 P pplioanYs urden to comply witt�,.
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
Fi No. ;WO (
ZONING PERMIT APPLICATION ( §10.2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: g‘ Mc -
Address: f)r,wkG,e) ?G Telephone: , - Y
2. Owner of Property: t , 1 I RUC t�
Address: a r"o Telephone: 5% C i.g"7
3. Status of Applicant: Owner Contract Purchaser Lessee
Other (explain):
4. Job Location: 1 D ( - I DC(yvto,i
Parcel Id: Zoning Map# 2 D Parcel# District(s): _
(T BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property Ns Co n
•
6. Description of Proposed Use/Work/Project/Occupation: (Usq additional sheets if necessary): I (''ec ^/
i Mce Re i 1 �
or et.n 5 e `2_4 1- f'Qv(C�i
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 )c 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 # / CJc 6
rl L T /CONTACT PERSON -) 2 - . /' - J 23
ADDRESS/PHONE: c U44t IJn ''..4 . ∎ P, 0/C) "3SS
PROPERTY LOCATION: /64 Da v del -',6 L
MAP /ID PARCEL: �� ZONE 6-..,
THIS SECTION FOR - OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
TONING FORM FIT .T.FT) OTTT L/
Fee Paid
Rnilrling Permit Filled nn
Fee Paid /2/ U ■_.--''
Type of Cnnctnirtinn•
New Cnnetriirtinn \.122 V -4,Ge 4 / -cnvf.0 -
Remndeling Tnterinr ' d /).. 2 ZtN_h 7 ,.
Addition to Fxicting ( 4, cJ r–tt �r
i �����Q
• r L ° �''C..N�n ,i C� Ale i_ [ y
- Building Plant Tnrliided-
Owner /Orrupant Statement nr :1;: - el d// 24 7
/ Sets of Plans / Pint Plan
T OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: 4 '
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 /ZOMNG BOARD OF APPEALS
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb from DPW Water Availability Sewer Availability
Septic Approval -Bd of Health Well Water Potability -Bd Health
} � ln P. mit from�Co se ton ,�� :'ssion f is 4. "v
Signature of Buildin V pector Date
NOTE: tssuanoe of a zoning permit does not relieve an applioant's burden to oompty with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public) Works and other appiioable permit granting authorities.
Iiiii �• City of Northampton UIRED INSPECTIONS
! ic, �s . 1. Footings and Walls
=`.1 ~ " .
BUTLDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
No. 912 Office of the Building Inspector
Zoning Form No. 962801 pp�� �/ Date 9/25/97 Fee $60.00 Check # 1714
18D 4 GI a2 / (./ C V
Page, Parcel ,Zone Section 127 ❑Yes 3 N
BUILDING
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Thomas Quinlan before Building Inspections
has permission to construct interior partitions &drywal Inspection on Site—Foundations
situated on 104 Damon Rd Inspection of Plumbing —Rough r
4- - - - - - -'-'-?)
provided that the person accepting this pemrit shall in every respect Inspection of Plumbing —Fuush 5-/ ' O
conform 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 4, - 1// 7/q7
Maintenance and Inspection of Buildings in the City of Northampton.
Any violation of any of the terms above noted is an immediate revocation A z Inspection of Wiring —Finish . r1?`t t�' t6 /q7 li9
of this permit Expires six months from date of issuance, if not started. ' g g Inspection —Rough Ott 1 1- 7-1 7
Note: A certificate of occupancy will be issued by this office upon return q , ✓ Insulation Inspection
of this card signed by the Plumbing, Wiring and Building Inspectors. 11
Building Inspection— Finish 0 Y 1/ 9 y qg• '`
Smoke Detectors (Fire Department) 4- - "6--17 /--- I ti 4'
Other
THIS CARD MUST B ` ; .. LAVED IN A CONSPICUOUS PLACE ON 1 PREMISES
Certificate of Occupancy /4--‹
!"�� B • ding Inspector