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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. / T. 19 Additions
' APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location 21 C.r`iiy.�c}�c➢ /�''S f/i L Lot No.
2. Owner's name Addresses /J . —0eW S i
3. Builder's name % �Ei�,E'Sc /V —Address 12,(41, A � , �� LI/�1X4
Mass.Construction Supervisor's License No. CS OG�S ff�� Expiration Date
4. Addition
5. Alteration ii�X/5 %" �ZAZS ok ?f 7,kAWiA.i .1,,y
6. New Porch
7. Is existing building to be demolished?
S. 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 cos6,�Ze, The undersigned certifies th the above statements are true to the best of his, her
}C�rr6�v1�
Signature of responsible appucant
Remarks
0,tig Cr i af 'Naxfllumpto-n
Q Axssnchntrllf
s DEPARTMENT OF BUILDWG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
W RICER'S COiyPENSAJION MSURANCE All , AVIT
vVith z p[-n(�Ipal place of business residence at
301 the jphooe",)
(st7�l/ci h/slalcJzi p)
do hereby cc[-tifj,, u-odcr she pz ns and pen216es of perjury, th>'.
/am an employer proved' , g the followu)g %vor'�_er's cornpensaiion cove:2oe for My
� P
employees oo Lhis)ob.
(mince copy) (POE Number) (Expiration Date)
( ) I am a sole proprietor, general con>sacr.or or homeowner (circle one) and have hired
the contractors listed below who have the folloWimg worker's compensation policies:
(Name of Contractor) Qmsuranc:.Comp--a, Pohc-f N=b-T) (Expiation Datc)
(Name of Contrz(nor) (tnsur�c ConpyrPoGcf Numcer) (E�puano❑Due)
(Name of Contractor) (1n_su1-anc� Colapan)'1Pobc-f NumLX--r) (E-x-pLaaoo Daic)
(INiame of Contractor) (Lnstuanc:.Compa ry/PoLcy Numb.^S) (Expiration DaLc)
(ul�cll adclr0 oo>1-boat tfocca to c:..Udc ufo-miEca to 1J ccc -�vnl
( ) I am a sole proprietor and have no one worEng for me.
O I am a-home owner perfommno all the work myself.
NOTE:p I c be a m th i v:biJo 6ccDCnm �t bo employ persons w So t a.>c n uoa c rp�u wocic oa.C"cLl n2 0(
oot most lh:n ti_a-w units in w{2iet1 tlx bF:t"^OwDCr;�-�do cc :Pp.utcn.ct th-:ctn u-c oc(Ecxr�l2y cocuS��to be
employrn uDdcr tbo vecK `x pca:p=.sti /,a(G L152_,�1(5)�appliuDon bf.bomcowxr for a l ceDx ce p�m 1 may cv t-�the
Icgil rtatx.of nn cszptoy>c under tho Wuicceg compomxt}on 1. c
[undcrstxnd that a o.Vy at thi.calcancnt—y bu foc}wrded W tbo Dcp,+rn-.:of ln.'.wJicl.\�dcnt!OfSioo of
oovcc>_Sc vcri6cs.ioo And that aiiu c to tccuc covcszbo ut,4a sccdi 2SA G(MOL 152 cw lazd t4 tb."imPoa6ca of criminal pca lncs
ooasistsng of x-fmc bcup to s 1-500.00 mc'Jcc unproocm 0(up to oocyr-.r. d avii paa.ttio io the fo<m oCa Stay WorkOrdcr aad a
film oCSt00.00 x dxy xgaimt.ay—
tgn y otr 1997 Ford vat.,.°ply
�. Permit Number ....
Lot t!
S Qua of crmiticc
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.
Thin cola= to be f111ed 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:
(Lotarea minus bldg
' &paved parking)
# of Parking Spaces
# %f Loading Docks
Fill:
'4vol-time--& location)
13 . Certification: I hereby certify that the tained herein
is true and accurate to the best of my�K
,1
DATE. C APPLICANT's SIGNATU �
NOTE: lasuanoe of a zoning
g permit does not relieve an pplioanrn burden to comply wlt",,all
zoning requirements and obtain all required permits f m the Board of Health, Conservatlon
Commission, Department of Publio Works and other a0plloabla permit granting authorities.
FILE #
SEI' 5
File No.
o)1123e�' '
ZONING PERMIT APPLICATION (§10 . 2
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address:/3 L1wI-f Telephoner1� -
2. Owner of Property: ( i� f� 1�/C,�,�lf S(�� /�Li�S �✓��
Address:_, � C �S1T�1 Telephone:
3. Status of Applica Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: �:/9en, '4 %C_i,`T
Parcel Id: Zoning Map# Z Parcel# District(s): �!
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property _
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
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#
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
SEP 5 J
APPLICANT/CONTACT PERSON: M"t 64�� .31—
*. ` ADDRESS/PI1,Qn-..=
PROPERTY LOCATION:
MAP C),3.B PARCEL: fAz& ZONE /�
THIS SECTION FOR.OFFICIAL USE ONLY:
PERNUT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM EH.T.FD OUT
Fee Pnifi
'Building Permit Filled nnt
Fee Pnif
4
Addition to Fxktin2
Accessory Strurture
-3 Sets of Plans I Pint Plan
v._..
THE F�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 mmission
19 '19 1/-�
Signature of Building r Date
NOTE:Issuanoe at a zoning permit does not relieve an applioant's burden to oomply with all
zoning requirements and obtain ezll required permits from the Board of Health, Conservation
Commission, Department at Publio Works and other applioable permit granting authorttlas.
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