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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No._ Alterations
NORTHAMPTON, MASS. 1 g Additions
1
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location /4),)-,)- /P c� ,L Lot No.
2. Owner's name c Address
3. Builder's name ��/ -- Address / 7
Mass.Construction Supervisor's License No. ,��'`�`�� l Expiration Date
4. Addition _
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
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost-
The undersigned certifies that the above statements are true to the best of his, her
knowledge an belief. ! ��
Signaturt of rtsponsible appicant
Remarks
s a Grit Of Wart4alliptnn
I 4
I,�w_ 'tiSEBC�ttECtl4
C DEPARTMENT OF BUILDMC; INSPECTIONS
PTOF A?, azj_ 212 Main Street ' Municipal Building
'
NORTNAP��rC)�,. ;vrtift�ufd;� � � p g "°..
M,A 01060 . _ Northampton, Mass. 01060
WORKER'S COTYITENSATION INSURANCE A MAVIT
(1►cevsec/PeTmi8ee}
with a principal place of business/residence at:
/ c/ _�/✓ ,� -r (phone#)
(street/city/sta dzip)
do hereby certify, under the pains and penalties of perjury, that:
O I am an employer providing the following worker's compensation coverage for my
employees working on this job.
(Lnsl Ilce 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:
(;Tame of Contractor) CoinTMaay/Poticr N=k-0 (Exp-imbon Date)
(name of Contractor) (Znsurancc Compam'[Pok—',Ntunc-'-r) (Expir Lion Date)
(Name of Contractor) (Insurance CompaIIy/Policy Numbu) (Expiration Date)
(Name of Contractor) (Insurance Compauy/Policy Numl;u) (Expiration Date)
(attach additioail s.cct if nccc= y to iaformstioc Pctaining to all cca.7adon)
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 aware that wbilo homeoµncra who cc-aplay pert=to do nl&iDt^,l cocsn ctioo or repair worst on a dwelling of
not morn than throo units in which the bomoouncr raside:3 or oa the giou,,:s appiutensnt t¢ccto arc oct generally ooasidcrcd to be
employes under tho worker's oompc ioa Act(GLl52--s 1(5)),application by a homeowner for a license or Panlh may-ideate the
legal etatua of an c=ployoe under tho Wockoes Compoo"iioa Ad.
I understand that a oopy of this clatcmcai may bo fb,,-. ed to tho Dcpertmcut of Iodusiial Accidea&OffiO°of Irrnu.noo for the
coverage vaifieatioa and that failure to&oatre cov,- r-o under scedoa 25A of MGL 152 can lead to the impositioa of a M'W pta cs
ooausang of a fine of up to S1,500.00 an&or imprisoarncr of tip to one yar and Civil pc wltia in the form of a Stop Work Ordcc and a '
firm 0(5100.00 a day:gains!tnc
For uio Doty
j! Permit Number
t.. t Iviap# Lot# t
ate
Si of T.iccascc.JPeimitice
• i
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 cola= 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 of Loading Docks
Fill:
4vo1-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge. 7
DA'L'E: �c3 � APPLICANT'S SIGNATURE �titii ���'
NOTE: Issuan a of a zoning permit does not relieve an pplioant's burden to oomply with all
zoning requirements and obtain all required permits from the Board of Health, Conservtation
Commission, Department of Publio Works and other appiioable permit granting authorities.
FILE #
jj
sE
File No. q)�
I
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: yQ1" :��t v
Address: / 7 aTelephone:
2. Owner of Property: L di
Address: � —f v �i�2� Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):__ �.4- L� Ce-j
4. Job Location: 2t-
Parcel Id: Zoning Map#_ 4 Parcel# :� District(s): /`I`� (0-5
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/P rope rty ��� �
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
i
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 N/ 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_2�__ 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#BP-1999-0268
APPLICANT/CONTACT PERSON Andrew Church
ADDRESS/PHONE 174 Spring St (413)586-0918
PROPERTY LOCATION 102 AUSTIN CIR
MAP 29 PARCEL 343 ZONE URA/WSP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildin2 Permit Filled out
Fee Paid
T}�e of Construction•� �
New Construction
Non Structural interior renovations
Addition to Existin
Accessory Structure
Building Plans Included•
Owner/Occoant Statement or License# `�
3 sets of Plans/Plot Plan
TH LLOWING 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
r f S-.,e tic Approval Board of Health Well Water Potability Board of Health
> 'IerMiit`from Conservati Commission
^a
Signature o Buildi fficial Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
Department: Reference No.- BP-.1.99.9-0268......
....... . .... •............
Building,Electrical & Mechanical Permits
......I..................................................................................
Fee Type: Receipt No:
....New..C.himney REC-1999-000656
....... .. ...........
PaidBy: ........................•--........•--
Paid in Full On:
Andrew Church
..................................................................................... Thu Sep 03 1998
.. . ...... ......
eceived By: .Check. . .No:...................
.Linda Lapointe 1328
.........................................................................................
......................................
DEPARTMENT'S COPY Amount.- $20.00
...........................
1)11" I.�'PARTM NT FILE COPY 102 AUSTIN CIR
CITY OF NORTHAMPTON
BUILDING PERMIT
Owner's pulling their own permits or dealing with unregistered contractors for applicable work do
not have access to Guaranty Fund(MGL 142A)
Issued: Permit No: Inspector: Tracking No.: Fee:
BP-1999-0268 $20.00
GIS#: Mai) Block: Lot: Address: Zoning: Use Group: Lot Size:
5067 29 343 001 102 AUSTIN CIR URA 12109.68
Contractor: License Type: Insurance:
Andrew Church HIC
Address: License No.: Insurance No.:
174 Spring St 104480
City: State: Zip Code: Phone:
FLORENCE MA 01062 (413) 586-0918
Project No: Categ-ory of Work: Const. Class: Cost Estimate:
JS-1999-0574 chimney rebuild $2,000.00
Description of Work:
CONSTRUCT SINGLE FLUE CHIMNEY
GeoTIVIS@ 1997 Des Lauriers&Associates,Inc. Signature: