29-526 (3) ' ` Z
a
Qzz� a
et
r- -,
�- � -� m
Zoning
Miscellaneous Additions,Repairs.Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. / �`� 19-12 Additions
APPLICATION FOR PERMIT TO ALTER Repair
a
Garage
1. Location ��S! G �' Qct o v.�► L ct v� 2 Lot No.
2. Owner's name A r-f-A A,:::: C-h Q C Address
3. Builder's name b fa vto4 A. :ZVLA v►.ty,n Address
Mass.Construction Supervisor's License No. c3s"679Q3 Expiration Date /�9f aaoa
4. Addition
5. Alteration
6. New Porch /o c•4 1.2"x/a" b-ecYl
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:- �. 00
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
Signat re ojresponsible app icant
Remarks
C� G
4
f
�r
ELI.
CqL,
r
F
r
t
I
I
f r
� Y
s�
I
� I
o
f
f
9'
� j
C-it� of Worthompton
Z
$ APR 1 41999 .: lassa�h�t$�tts
' ..,
la',SQE'T�r�VEP4"TMENT OF BUILDI]1G INSPECTIONS
INSPECTO 212 Main Street • Municipal Building
Northampton,MA 01060
Applicant Information �—�
Nam e— D o t i V c 7 n A 0,n---------------
Location —.-----------
c it y Alb a Vc ---- —--------------
1 am a homeowner performing all work myself
I am a sole proprietor and have no one working in any capacity
❑ I am an employer providing workers' compensation for my employees working on this job.
Company Name---------------------------
Address-------------------------------
C it y-------------------- Phone#----------
Insurance Co._------------_—Policy#------ --_
Company Name
Address
City —Phone#
Insurance Co. _Policy#
Failure to secure coverage as required under Section 25 A of MOL 152 can lead to the imposition of criminal
penalties of a fine up to$1500.00and/or one years'imprisonment as well as civil penalties in the form of a STOP
WORK ORDER and a fine of$100.00 a day againstme. I understand that a copy of this statement may be
forwarded to the Office of Investigations of the DlAfor coverage verification.
I do hereby certify under the pairs and penalties of perjury that the information provided above is true and correct.
Signature —Date
Print Name Phone#
Official Use Onl r,__Do not write in this area to be completed by city or town official
City or Town PermitlLicense# ❑ Ba2dingDept
❑Li^ewing Board
Check if immediate response is required
❑Sekctrnm'Dept.
Contact Person Phone#_
❑ Heahh Dept.
10. Do any signs exist on the property? YES NO I/ ,t { ,
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 COMPLE'T'ED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This colrmm to be Pilled in
by the Building Department
Required
Existing Proposed By Zoning
I Lot size
Frontage
Setbacks - frnnt -
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&Paved pa:kingi
# .of Parking Spaces
# '8f Loading Docks
Fill:
-(volume -& location)
13 . Certification: I hereby certify that the information contained herein
�r is true and accurate to the best of my knowledge.
.1
DATE: ��/4/cu APPLICANT's SIGNATURE
NOTE: lasuanoe of a zoning permit does not relieve an applioanVs b den to comply With all
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission, Department of Pubiio Works and other applicable permit granting authorities.
FILE if
4 It
APR 1 a 1%9
File No. L T7 1
`TP
OF 8g ,_ j�aS�F' T
---ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: D AvJ Q tiJd�v�Sv✓�
Address: qLl Q AI.J1 RBI. Will6DIkE (A Telephone: g 73 $q
2. Owner of Property: Ck OC -e.
Address: ;IS— rr:o�,r.A Leo -Telephone:
3. Status of Applicant: Owner j�Contract Purchaser Lessee
Other(explain):
4. Job Location: C;l - (j: f,tCf
Parcel Id: Zoning Map# '1�9 _ Parcel# > District(s):,/4-A --
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property 1— Fa%N1 �
6. Description of Proposed Use/Work/Project/Occupabon: (Use additional sheets if necessary):
�Iuc a �x[rs ��=.�► /� x/� p-eck
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 Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW Z 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 v' 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)
wjor
File#BP-1999-0844
APPLICANT/CONTACT PERSON David Johnson
ADDRESS/PHONE P O Box 390 (413)268-7389
PROPERTY LOCATION 25 GREGORY LANE
MAP 29 PARCEL 526 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: REPLACE EXISTING 12 X 12 DECK
New Construction
Non Structural interior renovations
Addition to Existiniz
Accessojy Structure
Building Plans Included:
Owner/Statement or License 055903
3 sets of Plans/Plot Plan
THEPLLOWING 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 Board of Health Well Water Potability Board of Health
Permit from Conservation Co ssion
Signature of Building Official- Date
Note:
{
M1
r
IL
Rv
I
I
I
25 GREGORY LANE { BP-1999-0844
GIs#: COMMONWEALTH OF MASSACHUSETTS
a :Bloch:29-526 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Cat Non interior r ovaU BUILDING
IT
Permit.# BF-1999-0844
project# JS-1 299-1492
Est.Cost 2200.00
Fee:$40.00 FRMISSIONIS HEREBY GRANTED TO:
Coast.Class: noactor: License:
Use Group; vio Johnson 055903
Lot SjZgbg.1): 5880.60 nor. I CE 1RENE
Zo_niu g:URA hnson
Tf_ 25 GREGQRY LANE
ADalcant Address: Phi Insurance:
P O Box 390 (413)268-7389
WILLIAMSBURG 01096 IS',Il.ED�QN:d/1bJ19990:00:00
TO PERFORM THE FOLLOWING WORK.-REPLACE EXISTING 12 X 12 DECK
POST THIS CARD SO IT IS,,YMEBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough; House# Foundation:
Final: Final:
Rough Frame:
Gas Fire Deyartment Fireplace/Chimney:
Rough: On: insulation:
Final:, Smoke: Final: dj •ft�-
THIS PERMIT MAY BE REVOKED BY THE CI F NORT ON UPON VIOLtploN OF
ANY OF ITS RULES AND REGULA N .,.�---'' ,-c7cie
i ture:
Fee Tn Receipt No: Date Paid: ' Check No: Amount:
Building 4/16/1999 0:00:00 $40.00
212 Main Street,Phone(413),W-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo