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=-3 i FILE I
9 r 7 , G. .
`j Nov 2 61997
• l'PLICANT/CONTAC ' PERSON: (C _ I ;�," / e
;qv /PI ,ONE: // .Lt ..tip Q '�� ,�•`�Cv /
PROPERTY LOCATION: / > 7,/a/)s rU•t(�r
MAP 049 j) PARCEL: / Z ME
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
7f)NTNG FORM FTT,T,FT) (lTiT
Fee Pairs
Building Permit Filled nut
Fee Pahl j'20
Type nf(-'nnctnirtinn•ri `����
New Cnnctrrtinn
Remodeling Tnterinr ��.�i���/ fJ
Addition to FYicting
Accessory Structure
Building Plans TnelnrletF
Owner/(lcrnpant Statement nr T.' ence # ) //1357S-
3 Setc nf Plans /Plot Plan
THFjFOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
//s 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 Conserv. ' , Commis on
—dot ,,//?,2
Signature of Building%..ector Date
NOTE: Issuanoe of a zoning permit does not relieve an applloant's burden to oompty with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Pubiio Works and other applioable permit granting authorities.
';i w
r
Nov 2 61991 ' 1 1
t}L9, ` '0 ) File No. 9 3a3-2
DEPT�Fa�,=._:; z7•� ����o�=�.��,�v.,�_,
ZONING PERMIT APPLICATION (§1.0 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: o/rk_.-✓ ii)?//'
v 6, -,.ovf. ,cx
Address: AC/4k_z '/ zo4 /-m2 4' SZ Telephone: .J 7- LC
2. Owner of Property: M// A Lt Z -r
Address: Si /Van6 Ale-4 Cr A7stireil ce Telephone: ' /�/.6
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: .37 NCJAc -A L s/ ,rk c,1Ce,
Parcel Id: Zoning Map# c2 4� Parcel# / District(s): 4
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property ,�->�G%?L-,y j .. C2.—t(��.e--`.
6. De ription of Proposed�Jse/Work/Project/Occupation: (Use additional sheets if necessary):
IC /o G 0.1 Lk rnrt-o/
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 1..---"" 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 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
&paved parking)
# of Parking Spaces
# of Loading Docks
Fill:
-(vol-ume-& location)
13 . Certification: I hereby certify that the inform.tion contained herein
is true and accurate to the best of my know ed;//
DATE: //22-6-97 97 APPLICANT'S SIGNATURE Ay 411/,
NOTE: issuenoe of a zoning permit does not relieve appii _ n •urden to comply wit '0111 i
zoning requirements and obtain all required perms from tl Board of Health, Conservation
Commission, Department of Publio Works and oth- applicable permit granting authorities.
FILE #
e 1997 Crtt r t,,zf NL#fiant hurt __*
$ �' u t 6 t.i13 6 Iaseacl<ttsctta �
i s — , —`=�t=
"'"', P7 0i- �" I)LFARTMENT OF BUILDING INSPECTIONS di
212 Main Street • Municipal Building __
Northampton, Mass. 01060 ��~ ow
/WORKER'S COMPENSATION INSURANCE AFN'!_DAVIT
I, -,75: /1_4 . / 7t=boi N(lc 69ce CA]
(h -�P� J
with a principal place of business/residence at: •
//Cl/71/1/4 t,g/ill .Z ,14 /v71.. G`'/z), (phone#i///-5-5/7- Lt
(street/city/stairlap)
do hereby certify, under the pains and penalties of perjury, that:
(lam an employer providing the following worker's compensation coverage for my
employees working on this job:
41/piiee 6 ir6cd yl 1 Kiss- =y-7 /G -6r'-2�
(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 ifneeenary 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 homeowners who employ persons to do mxinuuance,wnst ruction or repair work on a dwelling of
not more than three units in which the homeowner resides or on the grounds appurtenant thereto are not generally considered to be
employes under the workers compensation Ad(GL152,ss 1(5))„application by a homeowner fora license or permit may evidence the
legal statue of an employer under the Worker's Compensation Act,
I understand that a copy of this statement may be forwarded to the Department of Industrial Accidents'Office of Insurance for the
coverage verification and that failure to secure coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to 31,500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine 01 3100.00 a day against tae. fi/
Sign,. r..` day of t/ itO V , 1997 Foedegatm�aluseonly
Permit Number
�t1ai Lot# •
/1 a . V.. ;P LI.2IF,.- •ermittee
z
Iv
ril z;
v -a o•
3 � ;.4
z m
- *R 'V =_
:If,[ .1%.:-.) ,1
tz
1 "7
Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
!�'�
.. APPLICATION FOR PERMIT TO ALTER Repair //wiote�
� � Garage
1. Location 37 A/6/113/UCk /S7; �/r'e/lc e, Lot No.
2. Owner's name �-if�p/'ry UVC re(- Address / / &iaic(< S7— /c/crci1Ce
3. Builder's name-./ -)Ar _KI4tti WGS (ice gran r/5Lce Address //-6-/Mk, / t' �4/aw
s%1 4/46(...q.,
r
Mass.Construction Supervisor's License No. rfg CV
Expiration Date 0 3 -C 2- 1
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 GA....
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost:-/ 7,57 __
The unde signed certifies that the above statements are true to the best of his, her
knowles.e • , --li f
--___ �_
Signature of responsible app scant
Remarks IYC�F/U'c 77ei //L-C -n/./1/1 �'l /'/C1/"7 G/i'tl� �1 /914,1 �' 1 �C9�'`t�� //'I2t
!7 USe ._.- /-7.51-#-/// �T-/9- 4:t-V-‘) (- 616/S A CC