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23D-011
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C)mi O z a u FILE # 9! ;.-s 2;/ itu APPLICANT/CONTACT PERSON: 12c--�yJ s 27‘'"'/j ADDRESS/PHONE: - 4./.- .4 Afar /e (le 0 ' d PROPERTY LOCATION: / Ay,/ ; _ – _ ( n,/LA A / _ •st/ ..i> 4 ' MAP _ j 77 PARCEL: // ZONE r— THIS SECTION FOR-OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE 7flNINCY FORM FIT.T,F,T) OUT FeP Pairs Building Permit Filled nit // Fee Paid ��g `�6)— :..i'° Type of Cnnctnietinn- NPv Conctrurtinn r '4 4f .. &-GwGt -C, Addition to Fxicting Aee ccnry Structure : • .•. . ' . . . . • s • Owner/Oc _upant Statement n icence • el O, 3 Setc n PIaDs.)/Pint Plan THE F LLOWING ACTION HAS BEEN TAKEN ON THIS AP' ICATION: 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 Conservatio, ommission i / Za Signature o :ui . g Fetr. or 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 Publio Works and other appiioable permit granting authorities. NOV I ; 199, File No. 9 U ' ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: Am. £ Address: . _- . �� / Via'"phone: 2. Owner of Property, , _ Addressti-,2,) //./r) Telephone: _c? 3. Status of Applicant: Owner Contract Purchaser Lessee —4--Other(explain): (3�7-)-t ,m 4. Job Location: r20 .k, oar'/ Parcel Id: Zoning Map# D Parcel# J/ District(s): (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property 6. Des�tion of Propo edo/W• k/Project/Occupati ln: (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 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 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 ta) Frontage Setbacks - frnnt 3 4 G . - side L•. :34t L: R: - rear ctI /6 Building height Bldg Square footage o� %Open Space: (Lot area minus bldg &paved parking) # of -Parking Spaces # of Loading Docks Fill: =(vo1-ume--& location) 13 . Certification: I hereby certify that the information contained herein G is true and accurate to the best of my knowle•ge. DATE: / 1-- /"'7 9 2 APPLICANT's SIGNATURE /'�> / Ah..a,4 NOTE: Issuanoe of a zoning permit does not relieve an -pplioanf: 'card -��t• comply with all zoning requirements and obtain ail required permits from the Board of =alth, Conservation Commission, Department of Publio Works and other applicable permit granting authorities. FILE # 4cttAMP2.e **g °fl ' _ �'a wj y r (1B 4 �\I Crx f Cx fantp on lasascEinsctta : ' —= � JM,u ''� DEPARTMENT OP BUILDING INSPECTIONS . 212 Main Street • Municipal Building Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT C y (licenserJpeimitzee> with a principal place of business/residence at: 1� / • / _, (phone#) y/3-1„79 -yS- , (street/city/state/rip)/ 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) id'.•'!' .. : .-.,. . 'general contractor or homeowner(circle one) and have hired II e contractors listed belo s ho 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/Poticy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional sheet ifneocssuy to include information pertaining to all contractors) XI 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 wino employ persons to do maintenance,suction or repair work on a dwelling of not morn than three units in which the homeowner resides or on the grounds appurtenant thereto arc not generally considered to be employer!under the worker's compensation Act(GL152,ss l(5)),application by a homeowner for a license or permit may evidence the legal etatus of an employer under the Worker's Compensation Act. I undesatend that a copy of this eratcmcot may be forwardod to the Depertmcat 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 S 1,500.00 and/or inaprisourneat 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. Signed this / 7 day of , 1997 F«-d acrtas�nluseonly Permit Number 10 v.<4, i : A/ MaP# Lot# • of A.�wi i '_.: /* ....;;. , • • e /S- / --) c / S-0-1- - , - ' , 16 710/PA -.. ,,,-) 1, • i /06 ........ .. ■ Ix 36 ' 1„, •ov J JO ' ' . • . , r ■ I 1 . c.,_ ••.: ,y• „.,., 1 1 ,..., t • 1 c_„ I .4 C..".. a i 0 I ie.: ,,■.,,J I.:., ., t ; .. .t11 r.I. ... .`..-el- '■ . 1 ..3 , 1 Z f4 -,,c.,.',' ,•-•'' '.-7--' ‘j- ,.--, I ,r, I ;4 ' '• 1 .-..` V -3 ) il LI I , i ..-• i 0 f.,.) 0 X ..-."...0•::. LI W ,., I-', 2 t.3 z■, ...i.' 1 I 'il ■ el C.'4,,, . 'i r ' x■••••,I, Z :2, ,-,I . 1 r' 1 EL V •••• C.) ',q i-• h k ... ....) i -, C ',) i 41 • 113.3,.... ".1. 1 , -:-., C .:.D 0 . • „:_. 3.-1." 4 1 ............ i.3....3......- ....3.3...333. 1 • 1 I ■.3 ...3 ,,til ......) 1 I ! • .... ,... 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MATERIALS LABOR SUBCONTRACT No. Description Quantity COST tost COST co;; COST TOTAL COST • • -,._r ■ f ' C3 a 'fl 'd o t' -, ,. a .. > Z n z —1 m 0 C Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No %- .c. .Y Alterations Cr"%r NORTHAMPTON, MASS. // "' / 19 92 Additioni:a %4� APPLICATION FOR PERMIT Repair -•.;:: TO ALTER Garage 1. Location O j/ , „ � I l�/YI _� Lot No. o r F 2. Owner's name. _I . . ,_ _ £ ., _ . . . ,_ t •ddress _ / ,.te• 1 ,yam 3. Builder's name a �� Address _ ,_". / !� i yI� Mass.Construction Supervisor's ' : se No. I I ' • Expiration Date / ;.'I-- ' _ -_1.�/ 4. Addition .• �_ � .4110� . i � _sue _11 J - - 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 iii_z_4.4=.__,24tr,zji___.) 11. Distance to lot lines 12. Type of roof 13. Siding house 14. Estimated cos[ 2(3 O t Ct-D The undersigned certifies that the above statements are true to the best of his, her knowledge an. belief. _ , .......-......711P. A /ign_re . re..,sLble app,icant Remarks