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24A-126 (4) E T �1 co O m C R =' F a- r Z E _. ,gyp n o v' 5' ;n O r Z - , v --3 m o -7 c(/� -3 Zoning Miscellaneous Additions, Repairs, Alterations, etc. Tel. N•. / 7 ` Alterations %r NORTHAMPTON, MASS. ' / l q Additions t APPLICATION FOR PERMIT TO ALTER Repair `.- Garage 1. Location 5 ,9,7,,o,,-:-/-= ,� / 9 i23 Lot No. 2. Owner's name al, /> l /2 i' i ti, 4 Address 6 ii ,, e- %- ,$ /.' (l 3. Builder's name (? 1$/'/(' Address Mass. Construction Supervisor's License No. O', 4/e Expiration Date P 91 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 -�� g 12. Type of roof 1 13. Siding house 14. Estimated cost- n ,,� The undersigned certifies that the above statements are true to the best of his, her knowledge and belief. /` 4.) .. i L natu r of responsible app■icant ti , p - C-'L�- , 4 Remarks s � �_ JUN 1 3199 Crz #l�ai�tnn i - * = _ 7. +� w� ( � A lasaadinsetta °� �' - �W :c. - DEPARTMENT OF BUILDING INSPECTIONS =-2:11 `- 212 Main Street • Municipal Building ' Northampton, Mass. 01060 ' � `'� W ORICER'S COMPENSATION INSURANCE AFFIDAVIT 1, 6 . 4 C /Ai / oc/� (ipermittee) with a principal place of businesslresidence at: - >" /jl'Tj Y, .1ZI (phone #) hit . (stre°.,i/ci ty /state/zi p) 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 Dare) ( 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) (Exp lion Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale) (Name of Contractor) (Insurance Company/Policy Numb (Expiration Date) (attach add tiomi shoot if nocenaary to include information pertaining to all c actors) (am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE: please be aware that while homeowners who employ persons to do mairr1M.nce, construction or repair work on a dwelling of not mat than three units in which the homeowner resides cc on the grounds appurtenant thereto arc not generally coasidcrtd to be employers under the worka`a compensation Ac (GL152,ss 1(5)), application by a homeowner for a license or permit may evidence the legal ctatuz of an employer under the Wortcods Compcenatioa Act_ I understand that a copy of this rtatcc may be forwarded to tbo Departnmt of Jn al Accidence Ofhoo of Insurance for the coverage verification and that failure to secure coverago under s^Gion 25A of MC IL 152 can lead to the imposition of criminal penalties consisting of a. fine of up to S1, 500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a find of 5100.00 a day against tnc. Signed this /3 day of J ,,e 1997 For departmental Uoonly Permit Number _ r . ,- .., . l Map# Lot # Signature of Licensee/P. as tare , 10. Do any signs exist on the property? YES NO f/ 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 column to be filled in by the Building Department 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) #_pf - Parking Spaces # of Loading Docks Fill: vol- ume - -& location) 13. Certification: I hereby certify that the information contained herein G is true and accurate to the best of my knowled . DATE: f z.-g/9 APPLICANT's SIGNATURE / 1 "' NOTE: 1 of a zoning permit does not relieve an applioan s b rderi to oomply with zoning requirements and obtain all required permits from the a of Health, Conservation Commission, Department of Publio Worics and other applioable permit granting authorities. FILE # 4 = JL1N 1 3 1997 1 File No. �J ZONING PERMIT APPLICATION 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: (� /�'. ,. OdY Address: /'y PAfi 4' 1 15A Telephone: 637- ,4 y,t1,' 2. Owner of Property: J>jiJ,?1 //G1' 8f0r),r F Address: 6--, A D 5 c, S )?t/e Telephone: !9W - 04 - 41 3. Status of Applicant: Owner 1/ Contract Purchaser Lessee Other (explain): 4. Job Location: - 2 ljoe 08 Parcel Id: Zoning Map# 2V4 Parcel# /44 District(s): Ga--4 (TO BE FILLED IN BY THE BUILDING DEPARTMENT) / 5. Existing Use of Structure / Property rnzri.i. = — == 6. Description of Proposed Use/Work/Project /Occupation: (Use additional sheets if necessary): • ,A -C Gt -eLg. / a, 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) ( t s t. FILE I t 4 '� APP 1COI`IC • 1'idt'ACT PERSO „41/ ,A L1-CC‘Ce" PlEp .,, •. +«.: s : - / .t.... 11 . A-L O fc%,i - 7 PROPERTY /1 OCATION: 3 Q422t /)I- `..... MAP � PARCEL: /;z ( ZONE .- -C.�2i2 --C"`� THIS SECTION FOR - OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE 7nN7NG FORM FIT J,FT) OTTT Fee Paid Building Permit Filled mit Fee Paid % G %C� Type of Cnnstrurtinn- New ('nnstrurtinn ".. t`Z O j / Remndeling Tnterinr U Additinn to Existing Arressnry Strurtnre Building Plans Tnrinded- �/ Owner /Orrnpant Statement n>(Lirense ie7eizs 3 Sets of Plans / Pint Plan THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPrLICATION • //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 -Bd of Health Well Water Potability -Bd Health ! Permit from Conservation 'immission Signature of Building Insp.- • Date NOTE: Issuenoe 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 applioable permit granting authorities. City of Northampton REQUIRED INSPECTIONS t:1740 BUILDING 1 DEPARTMENT 1. Footings and Walls ! 2. Structural Components in Place* 3. Complete Building* No. 534 Office of the Building Inspector Zoning Form No. 962404 Date 6/16/97 Fee$20.00 Check # 1610 Page, 24A Parcel 126 , Zone URA Section 127 ❑ Yes © No BUILDING PERMIT * Plumbing and Electrical Inspections required THIS CERTIFIES THAT George Thibodo before Building Inspections has permission to reshingle roof over 1 layer Inspection on Site — Foundations situated on 53 Prospect Ave - Whitter Brooke Inspection of Plumbing —Rough provided that the person accepting this permit shall in every respect Inspection of Plumbing— Finish rm 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 immediate revocation Inspection of Wiring — Finish of this permit. 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 Smoke Detectors (Fire Department) and woodstoves Other THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON T PREMISES Certificate of Occupancy �►�' Building Inspec or