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23C-100 r it I o 70 V rrl Iy 00 D m a 3 © Zr r O c 0 R 'b z O C: 'v o: xi R ' cn Z F > m cn O . Z p --3 m Q ... v cS 7i `o rM eTs. Zoning Miscellaneous Additions,Repairs.Alterations,etc. Tel.No. .1 key Alterations ��%r` NORTHAMPTON, MASS. i(\44` -` 1 v 19 Additions ` A' ' APPLICATION FOR PERMIT TO ALTER Repair ' Garage 1. Location 24 `t WI'e.--'-' . .'i l C OC--c 1,1\A,� {1'`,U u' Lot No. 2. Owner's name �vc5 1X4--1"-= `' -'2_6.W'- Address 2tt L A-10-- ■ S'1 3. Builder's name CI`' -L7—c--`�`h'Nr■ Address 73 C ` -"1/4 cc `-T` Mass.Construction Supervisor's License No. O V 41 7 b. Expiration Date C 1,4- (c$ 4. Addition 5. Alteration W. ' F ,-y'' t....34,-, 0 G --ic.__- 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- 4e) Svc., The undersigned certifies that the above statements are true to the best of his, her knowledge and belief. Signature of responsible applicant Remarks Cv:J CcC..('-2s ?;..' ptr3 'eL.5c I S'` S �; � , aJ Jk} '- - W■t.t Vii".: 11- ■ 4-1, t- 5 :3:` e oay„a, W-1- I;Ec► Ks (..C' 7.2,-.71,:2,..0 .D*--kA —Z 3'T+`J C. (4.) J S S cc--3 A-c:, i ,!anti.lel..Mm[tlA,WatYleb. ■rS�■•1} y¢AMwO.,,,.wvJ7Av.fl .*'•,.w...... MORTGLAGE I LI I O ■ _. u//,,, ,_. '''''.--..--._ . I 1 1 ,. i ,..1 MAR I 01998 r • N 1 Pit` 1> >\ � -- V • - `.�/ , ` lT a� � i n ,. .\ 4f, 1 I / ii, 1 `,.___ /I \ , • t.oT � I. 1')(. . '.,\ ^, NIi.r -1-7/ 1111 • ..irC I hereby report that the premises shown on this Liar: is not located within a Flood flazard Area as shown on Department of U.U.D. Federal Insurance Administration Maps, Community Number 250167-0002A Identificatii Datee A ri173� 1978 y By:—R ? r.� �l`1 nd�-S'��r`,�, it = ---- TO THE 1 OWNER! Burger, Robert 11. ,�orthamnton Inst).tuti.On for Savings AND THE.14,2a,Lzers T tl.e Insurance Core LOCATION' Warner Street: __ Northampton, MA To the best of my knowledge , 1nfonna- of AMP7, o�o- ��o �"°� Crzi cif NortI &ntpt in =*_='� $rtt�� ► `Blasaacilnsctta -`v = �-.�� ' n o. i 01998 —._ _ .'W....4w v 1,'" DEPARTMENT OP BUILDING INSPECTIONS -1 i- 212 Main Street • Municipal Building _ Northampton, Mass. 01060 '�. ` WORKER'S COMPENSATION INSURANCE AFFIDAVIT I, CI L d3 c-C-C\e.--u ,,\A„ (licensee/permi ttee) with a principal place of business/residence at: `� 6 LEJ( c cs f'111- • (phone#) 'S--- S(f t 22-c� (street/city/siatrizi 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: L-k1k4v ttv ( —( CS- DO 0 9 .4-u/9 r '- l-k-y ( re 7S' (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: (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 sheet ifneocnuy to include information 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 while hom owocrz wto employ persons to do maintenance,construction or repair work on a dwelling of not moo than titres units in which thee homeowner raider or on the grounds appurtenant thereto arc oot generally comidcred to be employers under tine worker's oration Act(GL152,ss 1(5)),application by a homeowner for a license or permit may evidence the legal status of an employer under the W oric et Cooipemation Act. I understand that a copy of this lztatecneot may be foswardad to tbo Dopartmcad ofIndrutrid Aocidmtt O1Soo of Inwrznoo for the coverage verification and that failure to secure coverage=Licx section 25A of MOL 152 can lead to the imposition of criminal penalties oousistiag of a fine of up to S 1,500.00 atxl/oc imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fin of 5100.00 idly against tot. For dl use only • Permit Number - U ( qS WO Lot# Lice w $iglnahire of LiccnseelPermittcc MAR I 0 1998 File No. /t(' O ZONING PERMIT APPLICATION 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: 6 C3 �Lw vl„► Address: ' ir�9�t t t,' �� Telephone: y (2_ 2_ y 2 Owner of Property: i k■--.±-%., a " Address:` 2 f L4A, ►J - S r Telephone: ?`1 �� 62 c% 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): 66"—= c C 4. Job Location: 2 0W ' Parcel Id: Zoning Map# Z3 C= Parcel# I O'er District(s): i'S3 (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5 Existing Use of Structure/Property t`—'6 L-{= ■\ c `3 C 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): • 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 PermitA/ariance/Finding ever been issued for/on the site? NO DON'T KNOW ?`1 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) 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 $Wilding Department Required Existing Proposed By Zoning /,Iii (Vc,2C (; ('S� size Lot siz / / 0( ()c):, Frontage i✓t , D 6 g—c? Setbacks - frnnt 0 - side L: I (k-R: ,� i •t- L: I-CrR: j'Vf - rear Building height Bldg Square footage ;/-5-0 fi v %Open Space: ' ` ‘.?d (Lot area minus bldg C u eft) b () &paved parking) O b # 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: (() ( ` APPLICANT'S SIGNATURE 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 Publio Works and other applicable permit granting authorities. FILE # l l FILE I 963 89 ° r 98 MAR O1'9 APPLICANT/CONTACT PERSON: > fit-t � ADDRESS/PHONE: + 3 6 z _o-t-r.e_. C > / `t PROPERTY LOCATION: i CC/.4. 1 31( 1.-/ S_/ MAP 9 3 C_• PARCEL: / "e' ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILI,FI) OUT r� Fee Paid Building Permit Filled out e' Fee Paid C° � 7'7 r - 7 Type of C'nnctnictinn• Remndeling interior Addition to Fxicting Accecsnry Structure Building Planc Included. Owner/Occupant Statement nr Licence fl (' Qy ] Sete of Plane /Plot Plan T 16LLOWIN. G ACTION HAS BEEN TAKEN ON THIS APPLICATION: /� Approved as resented/based on information presented Approved P P 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 ission _.3/7 Signature of Building Inspector D e NOTE:Issuanoe of a zoning permit does not relieve an applioant's burden to oomply with all _ zoning requirements and obtain ail required permits from the Board of Health, Conservation Commission, Department of Publio Works and other epplioable permit granting authorities. 4 4 U ,. z y 0 a) y i t b 0 A a, o S pq 0 o •0 •.°u c •a o •� •- - a" a w U x 7 w i i , i i [z. 4 bU an S bn aA S 8 a g co S 0 0 ° 0 0 b.0 4 bA o r'F ° V yV� r ct , g § 0 0,4 . 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