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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
J,4A)0 Additions
a NORTHAMPTON, MASS. + 19
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location I C k�K SOX Ake Pi 4-4 Lot No.
2. Owner's name ? C f ' /T G- Address Jet-,G��Lf/1T T,
3. Builder's name Address,/
Mass.Construction Supervisor's License No. 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 rsign certifi at the a ve statements are true to the best of his. her
nowledge li
Signature of responsible app,icanl
Remarks
�$ 1 �z� of 'Nart1jailiptan . a
} 8
JAN 8199 A:jsnchnsitlf
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street Municipal Building
Northampton, Mass. 01060
W0 RICE R'S COMPE,NsAnoN INSURANCE Al,=Avrr
1
C � �z � c�
(li ccus�J�rali ttcc)
principal place of bua0ess/residence at
hooer�
no)
do hereby ceru-Cj' u-Ddcr i_he pzIns and pen116es of perjury,
lY1 r �m an employer providing the tollo%vu!g \vorkcr's comocnsauot) c0vc:2gc for my
employees worming o )ob.
(Instuance Cowp2-ffy) (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 coLnpcasa6on policies:
(Nnmc of Contractor) COMT-r-j/Poucf Numbs) (Expiration Datc)
(Name of Cont:mctor) tiTin6on Datc)
(Name of ConD:2ctor) (lnsur<nc-- C:omparr)'/Poticy Number) (Fxpb-.600 Datc)
(2'amc of Contractor) (Loau-ancz Compary/Poticy Numkr) (Expira�on Dzte)
(cnwh alditioozl cbctl if❑cca..ry co cc��1.rorm�;oa pc'...unng w.11«:rzr=won)
( ) I im a sole proprietor and have no one wot-Eng for me
O I am a.home owner performing all the vrork myself.
N0 1 pl.b,a Y1IC Itl i�w 0 t C Top-t1`.\N C II��Oy O�L4 W ll_V CDG LOO CG L?3 Y WO(k P 1 �C:t )z Or
poi mexe an-u ahmo uaiu La the 6ic<o;.a::"d"cr cn `ems-acx:;,c�s{�p�it�n�c:t:k;ctu uc ooC�cacrzli)'c�=nekrcd t�t:
ca ploym undec tbo�voci er`z er�per�=.tim l ci(G L152s l(��°FFI��°°by a Gem o o r far n t anx ec pera l may v cry L�c
le�l[tzb.,of m e=ploys under ho VJ«Y li Lo zpcm.S-ion AFL
I undcrriwd chit a Dopy of chi.m�,.,,,,-:a„y bo forwnr�led In tbo Dcpor�cni oIL'.u�iJ,�odrnct OrSi oo oI[�-��.r�oco for tip.,
mvc�xsc vcri.ficlioo and ttv,t 152 c 1.l d to tbd itapozihco orcric�Mies
eomiztSUg or a..Fux brup to 51,500.00'xYcr impciaocscni of up Lo Doc yc--�r IDd ays�pea=.Itio is the tocm ora Step Wort;Orcict and a
fiW o(S 100.00 a&)'igsiasi.mc.
S i cd t b i5 y of %(J 1997 Ford p�rcoxsGxt wo onty
Pcrm.it Number
M2 P-4 Lot 9
Si tum of U czmiuzc
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 colrmm to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks -frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
' &paved parking)
.of "Parking spaces
# of Loading Docks
Fill:
Avol-time--& location)
13 . Certification: I hereby certify that the i r do ntained herein
G is true and accurate to the best of my owle
DME: /C —� APPLICANT's SIGNATU
r" NOTE: Issuanoe of a zoning permit does not relieve an pplioanYs burden to comply with,,all
zoning requiremants and obtain all required permits m the Board of Health, Conservtation
Commission, Department of Publio Works and other ppliombla permit granting authorities.
FILE #
d ' i
JAN 8 1998
r + File No. o i
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
AddressZ.f'�e�s rL/0� �y19�t,1�r Telephone:
2. Owner of Property:
Address: �f /'l/<i c /l��Ql7�,�iy1a� LYUTelephone:
3. Status of Applica Owner Contract Purchaser Lessee
Othe r(explain):
4. Job Location:
Parcel Id: Zoning Map# Parcel# District(s): /< /
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Prop sed Use/Work/Project/Occupation: (Use additional sheets if necessary):
/-' %D E /L
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 Departrnent Files.
8. Has a Special Permit/Vadance/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 # < J J/
' ' tip.,^ i
�A-Y&PLIdWWON)iACT PERSON:O j SS/PHONE
PROPERTY LOCATION:
MAP 3. PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FULED (-)TTT
Fee Paid
Rifliffing Permit Filled nnt
Fee PAid 962/1, 571 S
134ne of Construction-
t./
�9 �.--
..i
THE 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
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 Conservatio missio
Signature of Building Inspector Date
NOTE:Issuanoe of a zoning permit does not relieve an applioant's burden to oompty with ail
zoning requirements and obtain all required permits from the Board of Health, Conservation
CC.OMMInsion, Department of Publio Works and other applioable permit granting authoritles.
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