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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 'ar Alterations
NORTHAMPTON, MASS. '7/1 1952 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location 3 3 S &Zoo&cdo'h //?C L N Lot No.
2. Owner's name Pry"& L 6t f L-AQ M Address_l') l:n')P-fk.)&-*)I? cr2CC44
3. Builder's name 42/x1 U 10 /V• by 4 f 1/2/Z Address_ I ;Z �AUrZti?L S
Mass.Construction Supervisor's License No. Q B 0 4 Expiration Date 1 f 9 8
4. Addition
5. Alteration
6. New Porch
7. Is existing building to be demolished?
8. Repair after the fire
9. Garage D f i R C,ti C-0 No.of cars Size
10. Method of heating
11. Distance to lot lines �e 9 Lf t L, �� � K'• � I �3. �N.ti �
12. Type of roof _ Pr04L f P14 11 6, A 9 5
V
13. Siding house f A/•Y i-
14. Estimated cost:-
U(JU ► 00
The undersigned certifies that the above statements are we to the best of his, her
knowledge d belie �.-
I/ r
Y Signature of responsible app,icant
Remarks
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<m DEPARTMENT OP BUILDER G INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060 y
WOR CE,R'S COM ENSA77ON INSURA-NCE i t AVTT
(li�nser/peruli ti c:;}
with a principal place of business/residence at:
�v(,e rz C 15 C- honer'
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do hereby certify, under the pains ai_id penalties of perjury that:
( ) I am an employer providing the followurg \vcl r_er's compensation cove;-age for rnv
employees wonting on this job:
(Insurance Company) (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 compensation policies:
(Name of Contractor) (Insurance Compary/Policy NumbcT) (E)#ration Date)
(Name of Contactor) (La urance Company/Policy Number) (ExTp ratioa Date)
(Name of Contractor) Gas-Wanc-- Company/PcUcy Nu.mb!r) (Expiration Date)
(Name of Contractor) (Imtuanct-Compauy/Policy Number) (E)piration Date)
(attac3i addition./rfwci ifnocxisiry to include informr:i oo pertniaing w rill ooc�ndon)
(�am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be Awruc that wlnlo bomcowncn who cmp!ay pasoas to do ma%uica..c,,c=structioo or mpaa worst on a dwelling of
not moot than throo units in which the homoowncr rrsidcs or oa the grouaks:ppudenwt tbsctn arc Doe generally oowidacd to be
employers undo tbo woticcr'i.ccmpcmaiim Act(G 1,152,m 1(5)),app!uatioo!ry a homcow=for a lions-or permd may cvidmoc the
legal rtatna of an employer under the Workcez Compomitiou Ad.
I uMcrx and d-t a copy of this rh1--may ba focwwxW to tha Dcpnrtinm2 oflndu4rial Ancideafs Offs o of[assuzoco for dh
oovcrage vcri cation and that failure to Secure covcraV under scdioa 25A of MOL 152 can lmd to tha'impositioa of criminal pcnaltica
ooasistiag of a fmc of up to S1,500-00 and/or i Vpr of uP to orx year and civil pcmLltia in the form of a Stop Work Ordcr and a
fine of 5100.00 a day against tnc
Si ed this day Of J J y 199 7 Forde¢rtnCCal use oaly
Permit Number
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Signature of Li crmittcc
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10. Do any signs exist on the property'? YES NO "fir
IF YES,describe size,type and location: i
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 aol== to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size 130 0 G`� S4 fZ °�`�
Frontage �s
!ao `
Setbacks 3 9 ( 'Cl
- side L: R: 3?L L: b9' R: t
- rear t
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Building height
Bldg Square footage 2a` Sa F'
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S�y 7-.
%Open Space:
(Lot area minus bldg a0) 7S i
' &paved parking) q
,of -Parking Spaces
ffof Loading Docks
Fill:
-=(vol-time--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my kno Ledge
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D2 E: / 7 APPLICANT's SIGNATURE
NOTE: lasualnola of a zoning permit does not relieve an a lio nta burden to oom ~
PP Ply wltt�,,all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE if
JUL �7 i Fi I e No. i
PERMIT APPLICATION (§10 . 2
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant A) r r' f.f'r i2
Address: `3 2 LAv k g-( 51 , Telephone: 5?(, - S 9(o o--
2. Owner of Property: Y/U jj L A PL'4 A)r(1
Address: 3 �ob K 1��3' Cf I C S Telephone: Qty — QG 0 7
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):_ CQ h,rA/4C 6 2
4. Job Location:
Parcel Id: Zoning Map#�_ Parcel#6 District(s): •� �-
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property_ St iv r.1 CE a►f IL y
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
7 f 19AIzACott V r TEA G
7. Attached Plans: Sketch Plan !J 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/Vadance/Finding ever been issued for/on the site?
NO DON'T KN0W�_ 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 Il 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)
olFILE #
Jul I 1997
APPLICANT/CONTACT PERSON: Lla
PROPERTY LOCATION: y� �� '
MAP PARCEL: ZONE y_,Z2A
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
7.0N1rNG FORM FILLED OUT
Fee Pn*d
Fee Paid
41 'A- qet, nf Pinns a n
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T FOLLOWING ACTION HAS BEEN TAKEN ON THIS APFLICATION.
Approved as presentedfbased 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
it from ervation mi 'o 23,1,29,//
2
Signature of Building or Date
NOTE:Issuanoa of a zoning permit does not relieve an applioant's burden to comply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, department of Public Works and other applicable permit granting authorities.
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