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Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 24 S 7194 Alterations
NORTHAMPTON, MASS. / &�i 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair i---"
a
Garage
1. Location �7Y Ok-d /-eS4 S+- Lot No.
2. Owner's name F16 9 dq cr/(4r i Address 7 ? /lnw/," sIn
3. Builder's name [) A"j h VIsW A Address Vq A.,,'
Mass.Construction Supervisor's License No. Expiration Date C
4. Addition 1 f
5. Alteration 9 Q plop,, 'r X 3 !e!Ln r.,� , C e��c .rte r s^s Y do^�h f/� c� Q+2.�Q ✓ �n feu wn v 4 l�1/
-Aqcj�a *eloc-e bct4V, VCk ,,,Jr4
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 cosL- 3Px:)'0
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
ignature of responsible app icani
Remarks
�(VAa1p
O O
°$ JAN 2 C? 1 oo Q -
3 �4 AlsoRCE,nsctte
m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass_ 01060 y
WORICER'S COMPENSATION INSIMA-NCE AFFIDAVIT
(hcenStcJpermittec)
with a principal place of busmess/residence at:
A rlA _'11 Q4 W,(If v b s vn I ni A- (phone!,)
(street city/staielup
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 D=)
( ) I am a sale 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) (Expirntioa Date)
(Name of Contractor) (Insurance Company/Poticy Number) (Expiration Date)
(Name of Contractor) (Insurance Companylpolicy Number) (Lxpindon Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additico.l shtcA if nooeuxry to include inrorn Lboa pe:tnimng to all ooatra r3)
t� 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 whilo homcownm woo cmplay persona to do m iuica acr,coastruction'or repair work on a dwelling of
not moon than throe units in which the bomoowncr r caldcs or oo the grounds appurtcmui tbo d,arc not gcoa-,t 000ridcrcd to be
employes under tba workt:r`s mmpeasation Act(GL.152,ss 1(5)),applicatioa by a homeowner for a Gct—oc Pma�t may"id'tha
legal rinttsa of an omployor under tho Workoea Co�n Act
l undcreAnd that a copy of thin ctatcmcnt may bo fo wnrdod to tha DWp uncut of rndzutrial A.cci of .of Iuwrwco for t6a
covaige verification and that fad=to acatre oovcraso uocr socdon 25A of MOL 152 can Icad to the imPosition of a mind penalties
ooaiisaag of a finc'of up to S1,500.00 srxyoc isaprisoamwl of up to one year end civil pcm16c3 in the form of a stop Work Order and a
find o(S 100.00*'&Y agp iwt me-
Signed this 16 _day of jEi h 199$ Far departul'�"uao only
Permit Number
M:apg _Lot# ---
Sipmture of Li crihittee
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 COMPLE'T'ED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This color to be filled in
by the Building Dl.p, Z3 t
I Required
Existing Proposed By Zoning
I Lot size
Frontage
Setbacks
- side L: R: L: R:
- rear =-
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paced parking!
# of Parking Spaces
# of Loading Docks
Fill:
-(volume -& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: Z _ 16- 5;- APPLICANT's SIGNATURE_ ..IL�_
NOTE: Issuance of a zoning permit does not relieve an applicant's b den to oompiy with all
zoning requirements and obtain all required permits from the Board of Health. Conservotion
Commission, Department of Publio Works and other applicable permit granting authorities.
FILE ,
JAN 2 0 098
File No. V& 31& eT t
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 4�) 4 v'd /k !�;k V\SC, n
Address: P-."d po�- GU,>/Ia;,,,,,6IA41-elephone:
2. Owner of Property: F/o ff is,. izago 1 rh
Address: 77 /—e� 4ki, S-f Telephone: Scl /4,q 3
3. Status of Applicant: Owner _ L,��—Contract Purchaser Lessee
Other(explain):
4. Job Location: `7 P �n�� /�,,� 'S 1
Parcel Id: Zoning Map# Parcel# 0;b?eT District(s):_, ' /Z<�,
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5, Existing Use of StructurelProperty
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
RPD_�Qr4 1k"{IeV4 3`x 31 cwla,- iv-J' 644t^ 'f'im-ice A- yav ,J P RP�Yr r
C� P✓7nr s'Od'"p O y Pvv- ext+Gt'j -retrza "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.
8. Has a Special PermitNadance/Finding ever been issued for/on the site?
NO DON'T KNO AI ��'` 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_L<_ 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
JAN 2 01998
APPLICANT/CONTACT PERSON:
eg
f
� �ADDRESSI7� ON .
PROPERTY LOCATION:
MAP C s. PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FULED DITT
Fp� Paid
1341)e of Cnntnirtinn-
Gti — ✓
7C` �C�r
.Remodeling Interior
f
THE F,� LOW NG ACTION HAS BEEN TAKEN ON THIS APPLICATION-
A_
proved 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
_Stc Approval-Bd of Health Well Water Potability-Bd Health
Permit from Conservation mmission
,- 1.2 9/,/g,5
Signa e o i r Date
NOTE:Issuance o a zoning permit does not relieve an applicant's burden to oompty with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applionble permit granting authortties.
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