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Zoning
Miscellaneous Additions, Repairs, Alterations, etc. Tel. No. Alterations
%fir NORTHAMPTON, MASS. 9 Additions
kj'' ` APPLICATION FOR PERMIT TO ALTER Repair
-- Garage
1. Location 1 .91 lV v A p jt 4 I r) I cll./ Lot No.
2. Owner's name :3 c 0 c. I`t^'/ f 4 in. Address F Ai R. S i
3. Builder's name c. C i ld 0' A, 1 t Address / ) c ..1 c id A. i) II 0
Mass. Construction Supervisor's License No. 0 s 7 0A S ? Expiration Date 6 "'1
4. Addition
5. Alteration • 76* e c:i c'r, c- k? YIL ,A"' 1: P 0 I: j of 13 li id to d_
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
14. Estimated cost:-/// 500 S
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
5ZA-Allal t1,lN
7(
ture of responsible appicant
Remarks
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�W y UN:. D EPARTMENT OP BUILDING INSPECTIONS _711_
m 212 Main Street • Muni Building d l
Northampton, Mass. 01060 ND ' ,
WORKER'S COMPENSA'z'1ON IN$UT A_NCE A.FE DAVIT
f ` JO e J 19S?, s Li )
(li censcel perm; tt ce )
with a principal place of business/residence at:
1 /- . 75/4/1/44) /Jj4) RD (Phone#) 5 � � / - e3
(stye..., ici ty/staidri p)
do hereby certify, under the pains and penalties of perjury, that.
( ) lam an employer providing the following worker's compensation coverage For my
employees wortng on this job-
(Ins -a ano Company) (Policy Numb (Expiration Date)
( ) 1 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) sur na- Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurancc Company/Policy Numbr) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(nuadi adaiticml thcri if oocca-.ry to Inc -Kt& informnition pertmaninE to d1i oc don)
) 1 and a sole proprietor and have no one working for me.
( 1 am a home owner performing all the work myself.
NOTE_ please be aria. -e that vitiile hcmeowncra wbo employ pcssora to do mntir.rrn. n. wm ctioo:or repair worse oo a dhvelling of
not moo than throe units in which the homeowner mines or co the grounds appurtenant thereto arc not generally cocaina-ad to be
employers under Om worker's oompcnsniica Act (GL152,sa ( (5)), applintioo by a homcowncr for a liccase or permit may evidence tb
legal stabs, of an omptoyoe under tho Wocicc 't Compcm.tion Ad_
. I and :r tax d ttvt a copy of (lair mt.cmcsst may bo for-warded to tbo Dcpnrtaacot of Inbistriel Aoodmtf Otlioo of Inau oce for the
covrsx8e vctifieatioo and that Pismo to ueure eoverago (meter sic ion 25A of MOL 152 dm, lead to ibd irospositioa of cnmib-sl penalties ,_
ooaiist of x-fine bf up to 51 ,500.00 andter imptuono of Up to. year and Civil pay.tG es in tilt form of a Stop Work. Oidce.and a
. Eno of 5100:00' a by igainiltric. .
F 1 we. only
t • PCS7IIlt Hl1IIl�CY
- 6/ %jr` 11 (i. 't. ;:ra YCilp't J., i
- gah?rc c(f Lis c a�&JPcrinittcc :- Date :_,:. ..:rya..- ...,.
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 NQ(
IF YES, describe size, type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This column to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size rt 1
3� w o4 pruNl
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:
•
(volume - -& location)
13. Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge. •
DATE: ( -- —7 T APPLICANT 's SIGNATURE
NOTE: Issuanoe of a zoning permit does not relieve an
zoning requirements and obtain all required pp liont's burden to oom PIY with
q permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
JUN 51998
File No.
6
i 8itli
ZONING PERMIT APPLICATION ( §10.
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: „To f J /1 57 A/ 5 4
Address: i 1 S" Ts ! i t) Telephone: . P y" C) G )
2. Owner of Property: 3 ("# C 1 y r i/2
Address: FA 1 - 17 5 i Telephone: c P v" 9; 3
3. Status of Applicant: Owner Contract Purchaser Lessee
Other (explain): eSol /c(f /Z
4. Job Location: rc/ l'o c 94i.4i 3)'4x4) of'- 1`4 3l"
Parcel Id: Zoning Map# ,3 (9. Parcel# 1 District(s):
t v,4
(TO BE FILLED IN BY THE BUILDING DEPARTMENT) 47/3
5. Existing Use of Structure/Property Fr /t 5 /' a ) n /S t id /iti
•
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
/ ? Mc' -i' p4111'14L sic,))) i1`tillait7 c p cot %tT X 12.
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 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)
•
.. -1+ FILE 1 963634 )/76 .
AN 5 n
APPLICANT /CONTACT PERSON: 1 �' of d r , J _a 3 n l
ADDRESS/PHONE: I 7, / e ,or t .t II .1111,
PROPERTY LOCATION: 22- t s d
MAP____ PARCEL: /rt. ' ZO il � _ 4' ;
"
. _ y
'1'H1S SECTION OR- OFFICIAL USE ONLY:
PERMIT APPLICATION CNF,CKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FTT J.FT) OTTT 4./
Fee Pahl
Ruilding Permit Filled n t .------- Fee Paid ,
Tyne of Cnnctriietinn:
'New Cnnctrurtinn = , 1-el " Z i .? �
Remndeling Tnterinr
Addition to Fxicting .,- 11 /Z -JD-` 1 i-11,
Arreccnry Structure . __rte _....t - _ar
Rnilding Plan' Included-
Owner/Occupant Statement nr 'h ence # J C '7 ,D -- °
C am . -
3 Setc of Plan' / Pint Plan 4.-/"'
T FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
A pproved 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:
.,„ a ',,1 , ,, 1 • 4 ,. le Availability Sewer Availability
w , 'r ' ` t , ' 4:', , : "
Septic Approval Bd o 'Health e Potability -Bd Health
Pe �o • , �1 / W is ion
, ?e
Signature of Building Inspector Dat�
NOTE: Issuanoe of a zoning permit does not relieve an applioant's burden to comply with all
_ zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
. 1_ \ �.. l h a� M O REQUIRED INSPECTIONS
.C egeirou g v t 4 rw e - _ , t, I �' a i . 1. Footings and Walls
!'� _ :_ _ tom_ .1.. 14.1 d 2. Structural Components in Place*
3. Complete Building*
No.
1675 O ct t Z ;: in Inspector
Zoning Form No. 963634 Date Fee $40.00
6/10/98 Check # 1729
Page, 250 Parcel 251 , Zone 13 R } ' Section 127 ❑ Yes 0 No 19; jr Ill ' ,,,.1.,
B 9 '*F 3° I P'IJ a g e ..:...a..+ l �.... Y `, , .'
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Joe Jasinsk± _ before Building Inspections
has permission to remove partial t : in_, '1 - r Inspection on Site — Foundations
situated on Fair St - First Aid Bui lU . -- r .i _ Inspection of Plumbing —Rough
provided that the person accepting this ermi, shall in ever respect
Inspection of Plumbing— Finish
P Pe P P� ' Y p
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
Maintenance and Inspection of Buildings in the City of Northampton.
Any violation of any of the terms above noted is an inu nediate revocation Inspection of Wiring— Finish
of this permit. Expires six months 'icon' to of _,: ut x,.', i I.,, :;Ilt.F•ted. Building Inspection —Rough
Note: A certificate of occupancy will b:, 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 N A CONSPICUOUS - PLACE ON PREMISES
Certificate of Occupancy
Building Inspector