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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 1 q Additions
APPLICATION FOR PERMIT TO ALTER Repair Garage
1. Location 5/ f"" kj f:1� f' h r - �/ Lot No.
2. Owner's name /> 'it i 1J 1 n / ,f�„ f Urn Address `s
3. Builder's name -L • �� �� _ Address elf A(I
Mass.Construction Supervisor's License No. �sy� 5 Expiration Date f7 9
4. Addition � t �t /r vu.N, i 44 �'-
5. Alteration
6. New Porch
7. Is existing building to be demolished? A D
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof �,4k e,
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
S1 n'ure of responsible app icanl
Remarks C
4�H�pT
61997 Crzt oaf 'Nnzt4aillptvtt l
�AS5ACh118[�IS �_
DEPARTMENT OF BUILDING INSPECTIONS I
INSPECTOR
212 Main Street ' Municipal Building
_
Northampton, Mass. 01060
Square Foo age Amount
Basement @ .10 � Y �
lst Floor @ .40
2nd Floor @ .20
1/2 Floors, Attic, Garage .10 1
Deck, Porches .10
TOTAL
r
t
OQ"��MPTO
MAY 6 199
Ansonciltssetts
�v DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(liiermittee)
with a principal place of business/residence at:
(street/city/statdzip)
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)
( ) 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 "oml shed ifneoessary to iaoe information pertaining to all ooatred )
(, 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 awaro that while homeowners who employ persons to do maktenmce�suction or repair work on a dwelling of
not more than throe units is which the homeowner resides or on the grounds appurtenant thereto ate nod generally 000ndered to be
employ=under the wod='s oompensation Act application by a homeowner for a license or permit may evidence tho
legal stahra of an employer under the Worlds Compensation Act
I understand that a copy of this uatemeat may be forwarded to the Depertmcot of Ic>duitrial Amdea&Office of Iffiuraaoe for the
coverage verification and tlutt failure to secure covetnga under section 25A cf MGL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to$1,500.00 andlor k4risotm>ast of up to one year and civil penalties in the form of a Stop Worst Order and a
firm of S 100.00 a day against tnc
Signed this 7 day of 1995 For dgnrstme w use only
� Permit Number
/f �---
Mao Lot#
Si of Li ennittee
A4 61997
Al.
j
22
_
1
I
i
v
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 V,
IF YES,describe size,type and location:
11. ALL INFORMATION MOST 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 'Z /�� S. �jJ��T 16' ovc"
Frontage
Setbacks -frnnt o
- side L: �° R L: R:��
- rear
Building height /G
Bldg Square footage S-
%Open Space:
(Lot area minus bldg / U
' &paved parkingi 6
# of -Parking Spaces
# of Loading Docks
Fill:
_(vol-time--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowled e.
DA'Z'E:T� 1907 APPLICANT's SIGNATURE / .
?" NOTE: Issu oe of a zoning
g permit does not relieve an oanYs burden to oompty witfl,,pll
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting eauthoritles.
FILE #
MAY 61997
File No. cX�� 1
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: ✓,� /�.y�
Address: �,Y 15 ,rte Telephone:
2. Owner of Property: Ay r -6i'li a. 4111— 441
Address: J�S Al' Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# Parcel# S�3 District(s): L .����
(TO BE FILLED IN BY THE BUILDING DEPARTMENT
5. Existing Use of Structure/Property
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 Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW �r YES IF YES,date issued:
IF YES: Was the permit recorded at the R egistry 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 Y, 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 # 96 ?9- 0
f s,
t APACANT/C( ItiTTACT PERSON: Jel1
ADDRESS/P QNk: 610d:2
PROPERTY LOCATION: 29�:f ' /�C� _' �'�a�u-firs I, J�rZF Cc�'rt�
MAP PARCEL: ^ ZONE _ /� �a��
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FULED 01IT
Rernndelin2 Interior
Additinn
Tnrhided-
r �
�OLLOWTNG 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
!Perm om Co nervation Commi to lof
_.-
Signature o Bui ding Inspector Dat
NOTE:Issuanoe of a zoning permit does not relieva an applioant's burden to oomply with all
zoning requiremants and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioabie permit granting authoritles.
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