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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.N `�� L5 Alterations
NORTHAMPTON, MASS._�:Z //C� 197--;7 Additions
APPLICATION FOR PERMIT TO ALTER Repair
�-� Garage
1. Location <' - "A (r•L' �f'. _Lot No.
2. Owner's name Address__�� E'- _ (tom C
3. Builder's namer' Address -t=r-'� `
Mass.Construction Supervisor's Li erase No. Y xpiration Date
4. Addition ?Cann=
5. Alteration 06 c7
6. New Porch
7. Is existing building to be demolished?
S. Repair after the fire
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roofi�uC \
13. Siding house
14. Estimated co�. e)
The undersigned certifies that the above s ements are true to the best of his, her
knowled a and belief.
) . /
Signa espons le appicant
Remarks
R f rrf Xa fljantpton
- DEPARTMENT OF BUICDWO INSPECTIONS
212 Main Street ' Mwiiciptd Building mil,
Northampton, Mass. 01060 - _-_-'
"C31t t=FR'S COMTENSATION tNSURANCF AFMA.VIT
Oictrtcxlj�crr i(["�C)
a pii-nipal plar_e of` siness/residency at
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(stt`cJJc7 h'/s[a lcJn�}
do hCrc6y cz�:rtiCy, a jder tbc; pain:; and pci)al ies of per'ury t133t;
an erupioycr providing Uie followif)g v,,nxke- 's compensation c-ove;ac,e for my
('rnpl.oYCc-S :acjr-1 '-O9 on this Job;
� CozlP24y) (PoUty Number) (I.xp"ti6 Date)
atr_.)
( ) I am a sole proprieta-, general courmrtor -)r ho>Aeowner (circle aoe) and hare. hired
the cor.►tractors listed below who have thf; foilowiog worker's compensation policies,
(Name of Contractor) �t13�rangy CompanyRoUcy Numbct) Oats)
(Na-T-1r of Ceonoor) --- (Insurance Co�p2-Gy�'Poticy Numbcr) (Expi.radon Dale)
(N?mP of Contractor) (tasuraflCti ampaDy/Pobcy Numbcu) -- (Z X�iI3Ciots[�a.tej
(isamr of^.onmacrc:; � J(Ia.�tirana Comparry/Policy Numbrs} v (�I:;�it3Ciur,Hate)
(�.0.�c sh�iti ctu,S x e+j i f n ne.—.r.to ,1J 4-aciLntl.>(y}
sole proprietor azd gave rIQ 00C Working for me.
( � I am a horne oi"er pet-forraing all the work myself
NOTE plcau[r M,—thii-hi}o boxcvwn--�µbo=ploy pa"ui to do=L�* ,oj.&uaioa or rep,.ir wntk oo i d«t.11.in8 of
oot mare t6.sb ttu—unit:in which Lb,6&mk,Rmer taiaw or oa llso grouncia VV=Uusni tbado arc trX Cam-Vily ca=idc O -be
=ployaa uOdet tbo-NY4:a`s.at�cn Ark(G1,1 S2.3l(>)�e{s U"daa by a 6omeowv x for•litrnao cc Ix-713A tt>ay a tidnYc tix
lcg�l.tom.•of an�loyec uadtr the Wor�ccic Compemclioo hd_
1 ll�xsv.c,d eh�i ogPy a%i,Etxt®m=m.y ba rorwmi W to too ,ut urlaALLtr;til ntri4#rty orsoo ortmvr.oea rM thn
coybmcc vcif=iioo and tbU failwa to tcntre wwmi;*uorler wtioq 25A of MOL 132 ma Lead to the im�iw of-iar M pnsettaca
e+xcusc>a�or £tee of ttp to S t�QO-t](3=Nor impt6p==Z ,ohtp w«x yctr r,ad C;Q panttio3 is the form of. ar'd a
fula of S L00.(7c1 R day agnitut we
Sip'cd this (v y of 1997 rxsm �u,��,ry
Maw i.,ct IJ
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10. Do any signs exist on the property? YES N AL
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 col— to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
Lot area minus bldg
' &paved parking)
:of Parking Spaces
f fof Loading Docks
Fill:
4v01-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
_1
D?II"E: APPLICANT's SIGNATURE
NOTE: insuanoe of a zoning permit does not relieve an applioanYs burden to comply witt7,~$!i
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appiloable permit granting authorities.-
FILE #
.N� 41997
DEPT OF ► ?!'IPJSPF' , it4 File No.
-
hf1,d`.'
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: j— '
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Address: Telephone. 7
2. Owner of Property:
Address: ___Telephone:�s
3. Status of Applicant: Owner Contract Purchaser Lessee
di Other(explain):�1...,
4. Job Location:
11 Parcel Id: Zoning Map# Parcel# District(s):_
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
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5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
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7. Attached Plans: 0--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/Vadance/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? N,O 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)
CS
FILE #
O TACT P RSON:
D D
PROPERTY L CATION:
MAP PARCEL: � � ZONE,
THIS SECTION FOR�OFFICML USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FULED 0111
Fee PAid
Riii1ding Permit Filled nnt
-ate_
THE BLOWING 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-Bed of Health Well Water Potability-Bd Health
n ion
Signature of Building ector D e
NOTE:issuanoe of a zoning permit does not relieve an applioant's burden to comply with all
zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
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