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32C-254 . . :°_ o t N o cn Z > rn Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.L`f � c+ Alterations NORTHAMPTON, MASS. 196 Additions a APPLICATION FOR PERMIT TO ALTER Repair Garage 1. Location Lot No. 2. Owner's name / I"e b, ``� Address �1 Al 3. Builder's name_ r +�, /:r v v?-l� Address ZZX S '� ��' Mass.Construction Supervisor's License No. �t (� )��� Expiration Dates 4. Addition 5. Alteration �:�t V^ c ox !h v �� or, 01 0, 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 and belief. Signature ojresponsible appicant l Remarks t�"c�v.�.(� d.f ('1 (y1.� c`i (T f' Jryy� r� �12� tL, 3 - Aik' 7 VB a easaxrhnsrlts J GV m DEPARTMENT OF BUILDDyG INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 'J WORT R'S COMPENSATION INSURANCE A I ANTI (li censerJpemvtiee} with a principal place of business/residence at: c--( H"a' A�/ do hereby certify, under the pains .rid penalties of perjury, th�_r. ( ) I am an employer providMg 'Lhe covelIige for my employees worming on tins job: (lnsa=ce Company) -- --- (policy Number) ( piratioa Data) ( ) 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: (Nagle of Contractor) (Lusui-any Cornpany/Poky Nusnbc) (E-x ration Date) (Name of Contractor) (Insu nc,, Company/Whcy Number) (Expiration Date) (Name of Contractor) (Ins=c-- Company/Poky Nu bn -r) (Expiraaon Date) (Name of Contractor) (Inszuanc-e Company/Policy Number) (Expiration Date) (attach additioml shed if noccsisry to inc}udc infixtni. pcztnissing to ail ooauacon) I am a sole proprietor and have no one working for me. ( ) X am a-home owner performing all the work myself. NOTE:please be as arc that wlrilo homcowncra who cmplay pcmaw to do manaf ,.�coa�ou or repair work on a dwelling of ant nxcc than thre o units in which the bomeowncr r c=dcs a oo the gcxi appttrtrnaat lhucto ate oot gena-ally considacd to be cmploycrs under the work&i onion Act(GL152.ss 1(5)�application by a homeoava far a bom3c a permit may cvidcnoc the ItIpl ct—, of an cmployoc undortho Workoet CompomaLion Ad_ I undcrat)ad dh i a copy of thin ctmttmmi may bo forwarded to tho Dcpertmcba Ac idca&Offioo of bmumr ncn for tho covaxge vaificsiioa and that fadure to statre covcrago under section 25A of MGL 152 can lad to tba impos—of criminal penalties oomixtiag of a fine of up to S 1,500.00 and/or LVrisoamcnt of up to one year and civil pcaatUc3 in the form of a Stop W ode Order and a fine of 5140.00 a day against tnc J j/ Signed this �– day Of t/ /`'C'_ 199 7 F«-dcpatnr�nl tt,o only J �� Permit Number { l c Map4 Lot# Signature of Liccnsee/P ttCC k 12 31991 1 _. 72 f� _ I✓- t ��� 5� p oe {tee 'C cr i `� woJ Ci- v�1lt 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 CO2== to be fi2ied in by the baildiny 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 %f Loading Docks Fill: '4vol-Lime--& location) 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. 1 DA'Z'E: O�t ? 7 APPLICANT's SIGNATURE NOTE: Issuanoa of a zoning permit does not relieve an appli ant's burden to 0c, ply B witlp,.+pil zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Department of public, Works and other applioabla permit granting authorities. FILE # .._.. .._.,.�.d.. a .,...w,.,...,, , 1 Z 31997 n „ ,ryy Fi1e No. t ' d ..a ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: S�evctij J'/�1r1l, Address:{ a Cllr- Telephone:_ 7 J7iz r 2. Owner of Property: (1t�( f Address: —1�y 6[ LA'//,- J�� Telephone: 3. Status of Applicant: Owner _Contract Purchaser Lessee Other(explain): C, u,'1�'4r ► 4. Job Location: � 'I Parcel Id: Zoning Map# 3,��C_! Parcel# District(s): (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property R,C5,I filch 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): J --�r:Y"!o��,^�� r�c-.� '�` Y��"t(� ©7` �'�`� �D►/ �' `1 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_ 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# S. 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) a s FILE I p $ U K IQ M '2 3 097 , /j APPLICCANC ., �141(611L,T_ � 1 PROPERTY LOCATION: MAP PARC L• ZONE_ .e -� THIS SECTION FOR�OFFICIA L USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM MY ED 0111 'Riiilding Permit Filled-Gilt Aree-ssnq4 Structure Tnrlyydefi- Sets of Plans /Plot Pinn THE rP1�LOWING 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 I 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 Conservati Commission Si for ate NOTE:lssuanoe a zoning permit does not relieve an appiioant's burden to comply with all _ zoning requirements and obtain ail required permits from the Board of Health, Conservation Commisslon, Department of Publio Works and other applicable permit granting authorltles. z p� o `,Z, O' � '�'`U�-s 0 'D ,�'... � ►'� N p`�'� � _ mop L.1 con CL Fr OK cn a. > rl v' r m ,ix C4 CD ft 2, 511 a a. cr rn QG 0 on In b `A CD cr. cr. : c o' Gi 5 o ngc d rM = o \i