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Zoning
Miscellaneous Additions, Repairs, Alterations, etc. Tel. No. Alterations
%r NORTHAMPTON, MASS. 19 Additions
Repair
t k APPLICATION FOR PERMIT TO ALTER
,;�
Garage
I / ,�1
Pk4 Kiv‘,S 21 hit' inC (eed M .
el Lo t No 1. Location --Amin n M1
2. Owner's name rt4,c kt� Edtt C.it 4 ic4i �a Address o i i..• fit. 1 • A , • 1
a ��
3. Builder's name F S I ev h `J 4v) CA • Address Y1 &t t' e.1 r►�u AA, Ln f /k 7 M
Mass. Construction Supervisor's License No. Expiration Date /� p o y1
4. Addition I r x 12 r Coda. ��LL r 5 J avt �XiS+/14 Quite. 6 1oc� 1'o .i a
5. Alteration
6. New Porch
s �
7. Is existing building to be demolished? le 5 '' (. °.. 8 u •
8. Repair after the fire
9. Garage No. of cars Size
10. Method of heating
11. Distance to lot lines 7 c' ,.. so 1 L
12. Type of roof ao \if Self Sr?,tfero� sh+,1 „je S (ic)
13. Siding house 014 u.� , 1 kte-tr1�1C L _J
1A-e, j raoue C9-JV Kr ih h,,,,,,...,/, 14. Estimated cost: - 4 I t ` t. t 11
1
The undersigned certifies that the above statements are true to the • st of his, her
knowledge an . ef.
MG< /1A
Signature of responsible app.ica
Remarks
i V.-i Wit _ h (., 'K ?j s ive4 P i au. S e-
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��. DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building 1 =
Northampton, Mass. 01060 No
WORKER'S COMPENSATION INSURANCE '11BAVrT
T., 1' 'tu tp'�1i i.e. t7,1,�, -- -kt2 1 e `;, /iiiJ( veal '
// (licenserlpermittee)
with a principal place of business/residence at:
_1.? ‘ � 1)6vt" � 0 o+ wfeT 01 a1 C4v(phone #)- --
(street/city/state/rip)
do hereby certify, under the pains and penalties of perjury, that:
( ) 1 am an employer providing the following worker's compensation coverage for my
employees working on this job:
p .t 1 klettiAAVvaAA we 4 3 - "5" 91 - Set .
(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:
r ;rery% SI, ea (\.‘644101 iAitttx jtv-1 W * 33 S / sr3 `i
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional the if necessary to include information pertaining to all contractors)
( ) 1 am a sole proprietor and have no one working forme.
( ) 1 am a home owner performing all the work myself
NOTE: please be aware that while homeowners who employ pascal to do m . R,t■ construction or repair work on a dwelling of
not tnoce than three units in which the homeowner resides or ea the grounds appurtenant thereto are not gweralty considered to be
employers under do: worker's cc rs ion Act (GL152,ss 1(5)), application by a homeowner for a liceasc cc permit may evidence the
legal status of an employer under too Workers Compensation Act
I undetsuad that a copy of tide statement may be forww-dad to the Department of Industrial Aaadea& Office of Insurance for the
coverage verification and that failure to secure covcrago under section 25A of MOL 152 can lead to tba imposition of criminal penalties
consisting of a fine of up to S1, 500.00 and/or imprisotmoant of up to one year and civil penalties in the form of a Stop Work Order and a
fine of S100.00 a day against me:.
. J
•
Signed this P-(7 da of r via 199 7 For departmental uao only
Ili Permit Number
TI v { Lot #
Signature of Licensee/Permittee
,
10. Do any signs exist on the property? YES X NO
�
IF YES, describe size,
type i C P►mp ib(.11 ii.S
pe and locati
Are there any proposed changes to or additions of signs intended for the property? YES NO X
IF YES, describe size, type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This cols to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: 5p R:_ L: X 50 R: i
- rear
Building height 1 g '"
Bldg Square footage q'D 51-4;r -Ff
%Open Space: �r
(Lot area minus bldg S'0411; ,1 • � , rj
&paved parking)
# ,pf Parking Spaces /5 1 5
it of Loading Docks / 0
Fill: vv
J( vol -ume -& location)
13. Certification: I hereby certify that the information contained herein
G is t e and accurate to the best of my knowledge.
qN
DATE: VM APPLICANT's SIGNATURE
r" NOTE: Ise anoe of - zoning permit does not relieve an applioant's burden to oo with , .all
zoning req irements and obtain all required permits from the Board of Health, serv.ition
Commission, Department of Publio Works and other applioable permit granting a horit ;es.
FILE #
�tl
. •3
2 01991
titi File No. 96/0` 2
ZONING PERMIT .APPLICATION 2)
PLEASE TYPE OR PRINT ALL INFORMATION
�% �p
1. Name of Applicant: i4 S 1 �� G k,uc l etvkl �:o 1 (X63 rcch
Address: 100.464'6,a1 tom > st Telephone: Lf (3 SE < 1 ,
2. Owner of Property: li'c►M r, Alt
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser \/Lessee
Other (explain): /� �
4. Job Location: n IA O t v�s 2-1 �i I�u �c�-s
Parcel Id: Zoning Map# 1 Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property 5 r e (J IAStA 6.,s p0-0
6'& e r eikvtote a K►r\ 3 S )1W% MA v ?°13
•
6. Description of Proposed Use/Work/Project/Occupation: (Use additiopal sheets if necggssary):
444 54 14 ' k $ ra FGAt, - Ted Dtvre111.1
t
w v $ X i ce+ " S 'apt 11A u,, 5 i vv.k.b k r 1 , 1 wo re 5 Ltr
5k)role. 5 ktr4 rot g � ..
7. Attached Plans: Sketch Plan )4 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 Permit/Variance/Finding ever been issued for /on the site?
NO DON'T KNOW X 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 X, 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)
n r ` 11 `� FILE 1 f r ` � 516-4/967.)
� ∎ . t
I
..r_ �. .� (
• JL4 � 4 /CONTACT PERSON :: ! ; � - _ or' ,e
ADDRESS/PHONE:'
PROPERTY LOCATION: / �� _ . / c-- •, , - ,��r '. i .4 0 :-U;, A
MAP PARCEL: 1 ZONE A A
'MIS SECTION FOR - OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZnNTNe. FORM FTT,T.FT) OUT
Fee Pahl
Rnilding Permit Filled nut
Fee Paid SUS " 1020
•
Addition to Fxieting Pj ,[►e
A creecnry Structure d
Building Plane Included•
Owner /Orrupant Statement nr Licence #
3 Sete of Plane / Pint Plan
THE FF LLOWING 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 -Bd of Health Well Water Potability -Bd Health
Permit from Conservati omm" s"
02. 7
Signature of Building tor ate
NOTE: Issuanoe of a zoning permit does not relieve an applioant'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 other applioable permit granting authorities.
•�' City of Northampton REQUIRED INSPECTIONS
Ut- r %? a 1. Footings and Walls
.l = te r ; '
BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
No. 563 Office of the Building Inspector
Zoning Form No.
962427 Date 6/24/97 Fee $20.00 Check # 20885
Page, 5 Parcel 1 , Zone RR /WP Section 127 ❑ Yes ® No
BUILDING PERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Hampshire Educational Collaborative before Building Inspections
has permission to replace 6' X 8' storage shed w /8' X 12' Inspection on Site — Foundations
situated on 21 River Road - Camp Hodgkins - Hampshire County Inspection of Plumbing — Rough
provided that the person accepting this permit shall in every respect Inspection of Plumbing— Finish
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 O ' ./ ' ' - ISES
Certificate of Occupancy _
Building Inspector