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Zoning
Miscellaneous Additions, Repairs, Alterations, etc. Tel. No. Alterations
%r NORTHAMPTON, MASS.
1 9 Additions
Repair
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APPLICATION FOR PERMIT TO ALTE nn Garage
1. Location / R.t v -e Ar L - e E'011 Ca vv1 /body 1 -r' Lot No.
2. Owner's name }1a,N.eck.Ye e) ue'n rrr'.o.( Cnlbdr±., ,..i Address , ?0_7:ndurfri , O N. //a.MP
3. Builder's name 4 ) /9v e t 4 - . � " ` e 7 ti .Asp, ,A Address l i y A r, e l J it, 1 I t t1Q7/ ,e vv.r hu v
Mass. Construction Supervisor's License No. S Expiration Date (o/, --7 9/9r
4. Addition
�P. + ' -
5. Alteration MC"ir� 40 •,, ...0 / et .. t t _/V • � - : • •P SA 4 •• ) L• �, • ' �r IN p
6. New Porch
7. Is existing building to be demolished? NO
8. Repair after the fire
9. Garage No. of cars Size
10. Method of heating Hal A► -Ad 4 Cc u .0 "-4%-• co. w 0
11. Distance to lot lines
12. Type of roof Atcp r..l4-- cr■...,s1-4:e
13. Siding house Luno, P-1/
14. Estimated cost- 3 6
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Si nature of responsible applicant
Remarks
4 -(t1AMp2. i 2
� o o a 3e r�p� k0[CI11Y�7IITi � _�t = _ �
�`'� rig , i MAY 2 0998
9 ��5� ` � ,t.. Ata c sa xcbnsctta �= (1s
��++ e EPT OF $0 r�r il l , i RTMENT OF BUI G INSPECTIONS • `
212 Main Street • Municipal Building '
,_
Northampton, Mass. 01060 "
`"
WORKER'S COMPENSAl'ION INSURANCE A FIDAVTT
I, ,n 6,,cei A , k vSb,/,
(li censcdpermi ttee)
with a principal place of business/residence at:
h ilt Ariav- <''i.0 Avi fit( / ,rbaj
)f}'. 40960 c.,16?'
. 8'
, (stint/ city /statrliip)
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 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:
(Ntune of Contractor) ( Insuranc Company/Pohcy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Pokey Number) (Expiration Date)
(Name of Contractor) (Insurance Compaay/Policy Number) (Expiration Dale)
(Name of Contractor) (Durance Company/Policy Number) (Expiration Date)
(attach additional shed if noccoasy to include info mstico pertaining to all coatrndars)
(X) 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 aware that while bomeownera who employ per to do mairtimmor, aonmuctioo err repair work on a dwelling of
not m°°3 than tbrc units in which the bonnoosvoer raider or as the grounds appurtenant thereto art not generally ooasidered to be
employes under the worlter`s compensation Act (GL152,ss 1(5)), application by a homeowner for a licco3e or permit may evidence thc
lcgil ctntua of an employer under the Worker's Comps x t.io-a Act.
I understand that a copy of this mlcmarrt may be forwarded to the Deparmsm2 of Industrial el Amps& moo of Iawrznco for the
coverage verification and that failure to secure coverage under section 25A of MOL 152 can lead to tine. imposition of criminal pcnaltia
cooiisLing of a fine of up to S1 ,300.00 and/or iarlrisonmczn of up to one year and civil penalties in dine form of a Stop Work. Order and a
find of 5100.00 a day against Lac. ■
• For' deprtmrnsl tvo oahy
/ Permit Number ' -
_ a--d c s /ao • r M _ _ Lot
•
. Si& of LiocnseeR •ttee •
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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.
This column to be filled in
by the Building 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
&p ved psrki g)
# of Spaces
it 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: S4a07 APPLICANT'S SIGNATURE it a
NOTE: Issuance of a zoning permit does not relieve an a pplioant's bu den to comply witty $11
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applicable permit granting authorities.
FILE
r,
t
nal MAY 2 0 1998 l
'� PT OFD' File No . 9 ZONING P ERMIT .APPLICATION (10.2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 1) (}v% 4 . 70 k yt`t'o7 ✓)
eU D7e-�cjG)
Address: i/Lj gr i a ✓ /-l1 /! CC/i /flQ, ,n. S t A''3 Telephone: r G, R 7 3 .9
2. Owner of Property: r . . . . i -e . .. •, kOA/4 s a ,C
Address: 3 () _ % ,Arie.r,rf t-e(I nil /L Primp, Telephone: ,..C cfqrxy
3. Status of Applicant: Owner V Contract Purchaser Lessee
Other (explain): a^ wl I
4. Job Location: r'--- / Ai v�Y , L ed ,S`
Parcel Id: Zoning Map# `3 Parcel# / District(s): /
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property \.Vc.i vv Ca v.n
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): •
P e P fa -e. J'- e'i -e1` o ,7 ward taeS c ri / ex±nnc+,r' chcri c nci !4.ems - vnw.fo5
4 `T / t'r s r c t e = r a j - e l n r - e - ; ' Y . -1 e re 0 .ev- c. 11 L -- h sca (1 clv j to a (I eV1
•� • wo a+nO -' s' 6 Y. • . .../—. 1U[R A. ' al; iH - 1 4 0. C A t.t v+ • i ii 1 ■ e
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 Permit/Variance/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)
L . �u r .'� ? "9 / 1
/1
• � � � �� FILE 1 "
C
NAY 2 0 1998 .� _.
Pt 0 P LL ONTACT PERSON: ' ,r G �� : n- �t f 73 1
• "E: 3 O N /0 D 3 c) 3 90 Gd�� -�l al t C
PROPERTY LOCATION: ., l ie e -- AI . 0 • i f ice,
MAP 0 PARCEL: ZONE 4 A
THIS SECTION FOR - OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
7ONTNG FORM FIT,T.FT) OTTT ,-
Fee Paid
Building Permit Filled nut �/,,, s
Fee Paid ,- d'd 4!%;-/-6 C---"'
Type of Conctrnctinn• _
New Construction R- L-- epLext c:pekt & / .�'r`{' `
Remodelin Tnterinr it, 1 -'fli4 , (.iA- t��
rn .•
Addition to Eticting ,u�t`' r[ `eleteCsst4f 'J
Accessory Structure - 4'.L....k_
Building Plane Tneluded-
ir
Owner /OrruPant Statement nence if ' 5 •-'
3 Sets of la5r,c / Pint Plan ✓ .
T� F AT LOWING 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
•l Permit from Consery . ion Comm' n
.;;; s-S'----.;
Signature of Building Inspector Date
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 Public* Works and other applioable permit granting authorities.
o
/ 4
°�� °4. UIRED INSPECTIONS
City of Northampton RE y Q
p k ;;41th - I. Footings and Walls
`" S-�:'• BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
No. 1625 Office of the Building Inspector
Zoning Form No. 963559 Date Fee $40.00 Check # 227
Page, 5 Parcel 1 , Zone RR Section 127 ❑ Yes ® No
= BUILDING PERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT David Johnson before Building Inspections
install replacement doors w /new framing ,drywall bath
has permission to new cabinet s,& counters in kitchen Inspection on Site — Foundations
situated on 21 River Rd - Camp Hodgkins 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 ,//4/ c /. , 0 7 ,/ ->
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 / is / / th'
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 6 D: 7 ' q `f $- ,
** Install per Manufacturer's information: windows, vinyl siding, roofs Smoke Detectors (Fire Department)
and woodstoves
Other
THIS CARD MUST _ D PLAYED IN A CONSPICUOUS P ACE O P ' , MISES
'' �— 7 -A-' ter.
Certificate of Occupancy
/ Building Inspector