29-203 (2) � n•
cn D m
CD 3 Z m
in Z
o to O
Z 0
1
Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location 54 biz= j�`1 f�D ji 0 At� Lot No.
2. Owner's name I6AO 9. �'zl Address � cn/�J j-�R / �O�l/e t)C .- l�'X
3. Builder's name 13," rP s%pia � S - -4, L Address �'SB ��/ aK (�'f m�f��'�� ��`�'
Mass.Construction Supervisor's License No. Expiration Date Os—d-7- 7�
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
I3. Siding house W/ b i l 5/n i+v
14. Estimated cost:- "7
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
" �--
Signature ofresponsible p,icant
Remarks
•• l -
1 '
e
Acesnrhn'st11t
A DEPARTMENT OF BUILDDIC INSPECTIONS
212 Main Street Municipal Building
Northampton, Mass. 01060
WORZCE,R'S COt` TENSA`ZTON MSCRANCE 1 t AV r
aflf C, 1.) C
(li�us�lperuii ttc:)
�,.rlth a principal plat; of businesslresidcnce at:
�1 i/ ek, 40g, f �+/t?n /1�1�►t 77� s) �'il _(p b o n e,' )�'� '"�//G
do hcreoy coFuLf),, under Lhe pr!ns and pe0216es of perjury, tha
O I am an employer provid ig the folloW2ng \'.'O`�(e 's cotnpcnsauon covc:2gc for My
employees woring on this job.
� C � S - 5 ,
rr a CASv� s �
(Insurance COMP2-ny) (Policy Numbcr) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and bave hired
the contractors listed below who have the following workers compensation policies:
(Name of Concmmr) Q_nszu-an�Corup-LaylPolicy Numbcr) (Expiration Datc)
(Name of Contmctor) ORS-ur"nc-- Corup uyrPolicy Numcer) (Exvir,6o°Date)
(N21ne of Contactor) (Lasu cz- Coarpao-),/Poucy Numh'-'f) (E-pindo° Datc)
(I�'arzle of Contractor) (lnturanc--Compaay/Policy Ntlmrr-r) (E)cp u-aUO° `Ic
(t(lic�]�ddlO ocnl rboCf trocoei.+..ry to ei�t5c taro(IDi7 ea pC"._tIIIIs la �occY-�on)
O I am a sole proprietor and have no one worEng for me.
( ) I am a-home ovmcr performiDg all the"lock myself.
NOTE plc rc be aMa c hcl wJo cccrn4 rs tibo ern loy perzo s a 30 a�v�r cot n cl oa rc z Y work on z •<lluz2 or
not mccc th_n L rco units is wt cb d>, oc cc the oc<Evx z12y coc:dv xi o 1<
employ—under tbo w«kcx'x,c=p�ra.lr_t(GU 52,,1(5)�°F?Ucx'tr°by bomn wncr far a Gccax oc P'-- l �y c °x L
lc-pj rtah.or as—�ploy>c uadcc tho VJo t cla Compon it on AFL
I undazt,nd th.*L a coyy of thu *.r .-t—Y bu fo�wvd>d to tbo i?cQv+tr-mi of 1.�'�.u�-i cl�lcadmcf Offi oo of[aa.ic-�noo for tbo
coves-,g vcrificaiioo and that Gdil to g-w covcrabo trx cr scctioo 2SA orb(GL 132 cw.lu.d to tbo'tnzpanCco or�inibil P ��
oowus orx-Eve bcup to S 1-500.00 mc'Jcc anproocmcri oCup to o«.year-d avt�pers.ttia in the form oCa Stop Work Octics and
fim 0(5 10000 i day LpinA.Mc _
Signcd this _Z,:p 7 day Of 1997 ry
Pcrmit Number
Lot 9
Signature of Lio,-- JPc-Odm-
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 col— to be f!22ed in
by the Bn97d4ay 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)
f -Parking Spaces
# 'of Loading Docks
Fill:
4 volume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DME:NOTE: C `' 7 APPLICANT's SIGNATURE _ _� �
NOTE: Issu o® of a zoning permit does not relieve an applioant'a burden t)6 oomply wit
zoning requ remants and obtain all required la,tio
q permits from the Board of H Ith, Conservt�tlon
Commission, Department of Publio Works and other applioabla permit gr nting authorities.
FILE #
SEP 1 6 !01�i7
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: g y'?
Address: one: -'116 j
U 61
2. Owner of Property:_ ,/b 1�
Address:-.3 /6f-j Tr), 04 7/o,e 6,--)G�elephone:
3. Status of Applicant: Owner Contract Purchaser ✓/Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# L2� Parcel# District(s):
(TO BE FILLED IN BY TH BUILDING DEPARTMENT)
5. Existing Use of Structure/Property 1
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 PermitA/ariance/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)
p 04
' FILE #
SEP 1 6 199'
APPLICANT/CONTACT ER.SON•
ADDRESS/PHONE 290
PROPERTY LOCATION:
MAP PARCEL: ;2 03 ZONEZAd4LI&tom
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED 0111
]Rnildin2 Permit Filled njit
Ept, Paid
>v
Remodeling Tnterinr
Additinn to Existing
�--'�
T✓F�OLLOWING 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 Conservati o 9//8
Signature of Building for ate
NOTE: issuance of a zoning permit does not relieve an applicant's burden to oomply with all
zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commisslon, Department of Public Works and other applicable permit granting authorttles.
Oho i����'•.y
, = a, a till
En
C4 rr
CD C.A Cx t
G o o. "� ry
�-] a-k-< ° ebb d w
cr
F-L Cwt
alp (D
LQ
c�
a
`b °, cv
° F �' n
dooCD (D
rt o
O N rQ
VI C
eD
y �
0 0o
C!� CD °
r tzs o
Q. C y
al
G G G N OD
r E
r
o � 5
b I I j I n o5. n � �
s ?7 0 0 C. O ON -d
�.
G Q• � G �
G cn' O (M v Oo O v M C y
ao o a o a. b
® ` n
c. G o
Cn O O
i
i
I