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31B-309 (4) a-e > t3 z g < -. T w v - „c ,,,, ,:, 3 D C _ O r -s Z Ci n r. w et 2 —. v o ,o v 1 � Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.i7p .6 Alterations %r. NORTHAMPTON, MASS. V�j• / 19�y Additions k'•}`-,"•6-4� APPLICATION FOR PERMIT TO ALTER Repair Garage 1. Location C? r,"i77742 ✓ 7/U,-7 �� Lot No. 2. Owner's name J9/ Off' A O/-7�`Q,»f7� Address . 6 !t C 7 7c71 3. Builder's name #'IQt'Ve' /0/yeSSeC-t Address c >7J ` / 2c'7 T7 y Mass.Construction Supervisor's License No. 00 9 /9 Expiration Date /c. /7//95 X 4. Addition 5. Alteration ,6 1 7/./ /7.:(3 / / Q1--z/dam VIJ cz /.5 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:- i 740C), ©0 J The undersigned certifies that the above statements are true to the best of his, her knowledge and belief. s2 4a�r1_ 4. /l / iL'_ /l_« Signature of responsible appica Remarks PIG U991 S. t'r) f UC1/T-6 C1J ."- ‘ 141// - / 7 e I cc\ I\ ke (4/ 6/56)/W_5 zzcr O�-(t1Al•f pi,, 1991 a, �� -i 4 Crizi�r ,7f N�fliantpfan . 1 _*°� ,R�a , gcl ',�'"a� = lt ��� .0 .'. assRChrrsclts _�' •' .cn DEPARTMENT OF BUILDING INSPECTIONS _�r`_- 212 Main Street • Municipal Building Northampton, Mass. 01060 r' WORKER'S COMPENSATION INSURANCE AVrF 1, ///mt RVey P /1-45g s q (Iicensecipermittcc) with a principal place of business/residence at: <9W A:)0$26C 7s 1 . 4/0/A-71 /3T-64/ 4155 (phoney/)0—e' ' 7`'&0 (st .t/cit)'/state/lip) 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) s?,.;x<,. ( ) I am . sole proprietor general contractor or homeowner (circle one) and have hired the contracto listed ee ow who have the following worker's compensation policies: • (Name of Contractor) clnsurance 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 additiom!meet if noocc ry to include informxroa pertaining to all contractors) (• I 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 whilo homeowners who employ persons to do o*•irr}rnarx�,cowiniction-or repair work on a dwelling of not more than three units in which the bomoowocr resides or on the gouts appurtenant thereto arc ooh goner-ally coaiidcrcd to be employers under the worker's e cepeasztice Act(61,152 sa 1(5)),appticai5on try a homeowner for a license cc permit may cvidcnc c the legal etahsa of an employer under the Wocicoda Compoosaiioa Act I understand that a copy of the mlcme t may be fccward d to the Departmcot ofJoA,Teri al Accidere&Oftoo of Imuraoco for the coverage verification and that failure to secure covcrago under section 23A of MOL 132 an lead to the imposition of criminal penalties coosining of a Erne of up to S1,500.00 and/or' of to one • imprisonment up year and civil p�1tia in the form of Stop Work Order and a fine of 5100.00 a day against me J Signed this / day of CJ� , 199 For dep al tt,o only A v Permit Number A V' ' if 1, Ma Lot I! Ala— If>!A. - P*I Signature o •wa.5r'ermittc° 111 Do any signs exist on the property? YES ) NO - r IF YES,describe size,type and location: ! - X 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 &pawed 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: Ae / /9 7 APPLICANT'S SIGNATU• % NOTE: Iss noe of a zo ing permit does not relieve an appli ants • rden to comply wit -all zoning requirements end obtain all required permits from the =o- - of Health, Conservation Commission, Department of Publio Works and other applicable permit granting authorities. FILE # AUG 41991 File No ?6'„,,94272 ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: Si ff/)iPl'e'<',j� Address: c,2 y/ ffros p e c S* ' Telephone: 2. Owner of Property: l 0* • r hie O Address: G 1\----114 G Telephone: 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): CO In r Q C G 4. Job Location: o 00--6 I lc_ (t Parcel Id: Zoning Map# � Parcel# J(-) 9 District(s): e A (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property 0)'W1 C. E_ • 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): Of/(f) e x 16-61 u LS pckae ,5 tiv/r6 /-2 /,e Pt/ Wa//6 ' 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 )C, YES IF YES,date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW X 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 I 96 ?628 n API ANT/CONTACT PERSON: , t A /4 i � ' � 5-� -444d ADDRESS/PHONE: d (Y2 `r eir • PROPERTY LOCATION:' MAP 3/ 5 PARCEL: 3O? ZOr THIS SECTION FOR-OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FAH ,ET) ()ITT Fee Pain Ruilding Permit Filled ni Type of Constrnctinn• New Construction (---1..&4H2' a Z 44 ° Remodeling Interior 40-1 /new-, - �e, Addition to Existing Accessory Structure Rnilding Plane Tneliided• �,+, Owner/Occupant Statement n ence 6000-! /9 3 Sets of Plans /Plot Plan / THEF.OLLOWING 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 Perm't rom Conservatio om i •', _ r5.� Signature of Building •/ or Date NOTE:issuenoe of a zoning permit does not relieve an applioent's burden to comply with all zoning requirement's end obtain ell required permits from the Board of Health, Conservation Commission, Department of Publio Works and other applioable permit granting authorities. *0 /\ t 1 0 r z w C4 Pk E� U � 6 ..° on �,l� o U A �? 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