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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. s�7�' � Alterations
NORTHAMPTON, MASS. Z 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
a
Garage
1. Location 731 'TOOK- ' SC-_ N[3b +°d��` tJ+S n� Lot No.
2. Owner's name t; t� Address Zak -T 39�-, L�`c0� r
3. Builder's name u-*�,tt�tAM al Address R `i�-F10E =—LA '�Sr- c wt tik-k\?W ,
Mass.Construction Supervisor's License No. Expiration Date 1 Z/o4 /g'1
4. Addition
5. Alteration Ems.=� C�r
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-
The undersigned cert4that above st a[cments are we to the bes[ of his, her
knowledge and belie
Signature of responsible app lcanl
Remarks
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DEPARTMENT OF BUILDING INSPECTIONS
Main Street ' Municipal Building 'o
Northampton, Mass. 01060
WORKER'S COMTENSA`zTON INSURANCE A i A A.VTT
uz)I t_1__l
(li ccns--Jpermi ttcc)
with a principal place of business/residence at:
M� Oa2_" � (phone;{) �Z� oa-
(sQ�t/ri t}/stzirJzi p)
do hereby certify, under the pains and peaalties of perjury, thai:
O I am an employer providing the follo%V2rig worry er's compensation coverage for my
employees working on this job.
(Insurance Coap2ny) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, g eneral con tract or or homeowner (circle on e) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) Qn_suiancz Company/Pohcy Number) (Expiration Date)
(Name of Contractor) (hi-auanct- Compauy/PoUcy Number) (Expiration Due)
(Name of Contractor) Qn_suranc-- Compaay/Policy Nambzr) (Expiration Date)
(Name of Contractor) (Inswanc;�Compauy/Poky Number) (Expiradon Date)
(ertacb additional cboct ifnocra to inC}i>dc infocma!ioo perhimng to a coatrnrion)
( 1 a sole proprietor and have no one worlzing for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aw�rc that wbilo bomco%o who employ pcaom to do—;aicaanct ooastnution'or repair work on ad--Ding of
not morn than throo antis is which the homoovv rent&=cc oo tho gouo b xppttticaiat tb=w etc oot Scocraily 000ridcrrd w be
employes under tbo wotkrs's o=persxtica Act(G L152,s 1(5)�application by a bomoowncr for a liccwc cc pc fm may cvidcmc the
ltpl on- ofan employex undcrtbo Wori t eompoosation Act
I understand that of thl.�t®cra may bo forwarded to tbo Dcpart.x aftodutrid it oadca&OfS of lx=urwo for tba
covcrxgc vcrificstioo that 6111=to scwrc covcrago undo souioa 25A of MoL 152 can lad to tbd imposition of crimi W pcoal i-
000srsting of a-fine to S 1,500.00 an&or imprisooz #of up to ooe year and civil p®riid in the form of a Stop Work Ordcr and a
fim of S 100.00 a against tm,
J
Signed ZZ_day of JyL , 199 7 For doputmcow t—only
Pcrmit Number
Maps Lot i!
SignadAc of L.ic;cnscc-1Pcrmit1=
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 cols 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
' &paved parking)
# of Parking spaces
Cj
# 'of Loading Docks
Fill:
4vol-ume--& location)
13 . Certification: I hereby certify that the info tion contained herein
is true and accurate to the best of my knowl e.
DME:-,,�U try Z L c(--:� APPLICANT's SIGNATU
1" NOTE:_Iasuarioa of a zoning
g permit does not relieve an applicant's burden to comply withl,.4411
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission, Department of Publio Works and other applionbla permit granting authorities.
FILE #
21997 i t t 5
4vi
I File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: Ott-t�dv` 'D . '`-'1 ICt4E'l'«
Address: (� -?fAZICF-Lt-U £ka al) Telephone:-+— �)
2. Owner of Property: 4E}!
Address: x Telephone: 'EDE344- C53C 121-
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: z31 ?�/P.�S` GT"
Parcel Id: Zoning Map# d T D Parcel# District(s):,.,/-Zf-
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property ze-za> . ✓IL II
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 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)
FILE # 962571
1� APPLICANT/CONTACT PERSON: ;
yeas ADDRESS/PHONE: 9 ". ee
w PROPERTY LOCATION: d3 / WQ(
MAP PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FH,T,FD OITT
Fee pni(i
Addition to Existing
3 Set, of Pinns /Pint Plan
THE XLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATIOM
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 Healt Well Water Potability-Bd Health
it 0 ry "on
Signature of Building Inspector l5ate
NOTE:Issuanos of a zoning permit does not relieve an applicant's burden to oomply 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 authoritle-s.
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