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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 )ro Additions
Repair
APPLICATION FOR PERMIT TO ALTER
Garage
1. Location /d2 /9 c T, �o� /�/G1>?�.tJ t^' f f,,' Lot No.
2. Owner's name r f- � Cam= Address ld — 14)cl T�W Coe,(14-17 �/Qei��11c�
3. Builder's name V 0. 1 A)f- Address
O>- - V —
Mass.Construction Supervisor's License No. �.� `�� Expiration Date Ajuo
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 —`i� �% '1 S�� ~
14. Estimated cost��j'Sbo J^
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
Signal I of responsible app icani
Remarks
O�gt1AitP�� •
$ 3199 Grzf-'4 of 'Wart amptan
< t J5113aacanactls
m DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(licensaJpermittre)
with a principal place of business/residence at:
!j7/ 19¢4 <� A/QP1,-14 '7th h'�.� (phone
( city/s�alrlap)
do hereby certify, under the pains and penalties of pegury) thal:
(
1 -m an employer providing the following Nvorkers 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) (Insuran(-- Company/PoLicy Number) (Expiration Date)
(Name of Contractor) (insurance. Company/PoLcy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/PoGcy Number) (Expiration Date)
(Name of Contractor) (Lnsurance Company/Policy Number) (Expiration Date)
(assarh additioml rhea ifnooca. to ia�infvcmation pataiaing to all ooakactors)
( ) X am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
MOTE.please be aware that whilo hoaxxnY* a who employ p==to do mamicamor,coagnxuon:or repair work on a dwelling of
not mo"than throe units is which the hoMoowaer ride of on tho Vvjo lr:pputteaaot thrrcto arc cot generally oomiderod to be
amployrcra andcr tho worker's oompc nv4oa Act(GL152,r3 1(5)).application by a homeowner for a Gccnx oc permit may evidence tho
legal staters of as employer under thn Wodccez compomatioa Ace.
I understand that a copy of thin trstc,mmi may be forwarded to t11e Depnctmm2 of Industrial A.ocidoaCf O11ioo of Insuraam far dw
Coverage verificatioa aid that failure to sauro oovecago under soction 23A of MOL 15Z cM lead to the impos—of aimiaal penalties
00mit438 of rt fine bf up to S1,500.00 alwor imprison of up to one year aid dvt7 p=lies in the form of a Stop Work Or aid a
find of 5100.00 a day against mt—
For dcpartmxntd UOO 001y
/ Permit Number
lot
.,i Si�.tuxe.taf LiommedPermi
fidY°'r.,t"r I.AM" ..:4'...
•
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.
Thi..a cola= to be filled in
by the Bu±1 inq Department
REiquired I
Existing Proposed Ehy Zoning
Lot size
Frontage
Setbacks
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&p_aved parking)
# of Parking spaces
# '6f Loading Docks
Fill:
_(vol-ume-& .location)
13 . Certification: I hereby certify that the information contai:nted herein
is true and accurate to the best of my knowledge.
DATE: �.,rr�� APPLICANT's SIGNATURE� �
NOTE: Iss anoe of a zoning permit does not relieve an appliomnt's burden-to v oo mply wiU7 4111
zoning requirements and obtain all required permits from the Board of Healtl h, Conservation
Commission, Department of Publio Works and other applicable permit grentil -ag authorities.
FILE #
3
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APR 3 ia%
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION �+
1. Name of Applicant: 5ro u C7 ? - �%��' !3 � 91�J�j✓
Address: 7�l fin, �f / -C ✓o ,�dt•9nr, 7Gti A-Telephone: 5-9e;
2. Owner of Property: �!/u'.��✓� r`��
Address: 0;; /'-J 63—7.1 �R�,l� �d,Lr''Nc� Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# � Parcel# L, L3 District(s):Z-eld �Gc
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5, Existing Use of Structure/Property ^'-
6. Description of Proposed Use/WorkJProject/Occupation: (Use additional sheets if necessary):
v/ NY 1 V(!�-
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.
S. Has a Special Permit/Variance/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 # I J ( ��
APR 31i 998
APPLICANT/CONTACT PERSON: k&f �� � u' �5 ,_ •5!/!�`�
ADDRESS/PHONE: ',2,?F - X_)ci
w_ PROPERTY LOCATION:
MAP 9 PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
MNIENG FORM FILTED OUT
Fee paid
Rnilding Permit Filled 011t
moo—
Z
THE F LLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
Approved as presentedfbased 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
!Permit from Conservation mission
.--'' _
Signature of Building or Date//
NOTE:Issuanoe of a zoning permit does not relieve an applioanYs burden to oomply with ail
zoning requirements and obtain ail required permits from the Board of Health. Conservation
Commisslon, Department of Publio Works and other applioabie permit granting authorlties.
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