Loading...
35-049 (4) � I v > o ;� tv � c 7t7 � m 3 c oL4n Z Cn � r > , cnO Z rn ° a I e Zoning Mi-scellaneous Additions,Re pa irs,Alterations,etc. �Tel. Alterations NORTHAMPTON, MASS. �` I rris� Additions APPLICATION FOR PERMIT TO ALTER Repair ,` Garage 1. Location r' l='- it - '` Lot No 2. Owner's name s ' .- - G` - Address -a '".;%'` -. ✓� 3. Builder's name Address �p > Mass.Construction Supervisor's License No. / 3 Expiration Date�Al. 4� . �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- r` The undersigned certifies that the above staterneI s are true to the best of his, her knowledge and belief. z� - Signature of responsible app,iccJa//nt Remarks _: b � o C E '!7 rte.► G O r` O z Z m � A Zoning ieous Additions,Repairs,Alterations,etc. Tel No. ��� /�YAlterations NORTHAMPTON, MASS. i Additions Repair APPLICATION FOR PERMIT TO ALTER Garage ttion Lot No per's name Address Ider's name ,- E � Address 5` 1 p�� Expiration Date us.Construction Supervisor's License No. + Idition Iteration iew Porch s existing building to be demolished? Repair after the fire Garage No.of cars Size Method of heating Distance to lot lines Type of roof Siding house 1. Estimated cosL- 3;lcr-ee The undersigned certifies th jlw above stateme is',re true to the best of his, her knowledge and Signature ojreaponsible app,icant Remarks '� ° o oy a � .. 'its Jaf '"axf4&111:rfull X m DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFMAVIT (lieenserJpermittce) with a principal place of business/residence at: 1 G t_ C ones#) /��� - 12— (Strr u6ty/ zip do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following workers compensation coverage for my employees working on this job. (Insurance Company) (Policy Number) (Ex-piratfon Date) ( ) I am a sale proprietor, general contractor or homeowner(circle one) and have hired the contractors listed below who have the following worker's compensadcn policies, (Name of Contractor) (Inai ance Conipany/Poky Number) (Expiration Date) (Name of Contractor) (Insurance Comp my/Pokcy Number) (Expiration Date) (Name of Contractor) (Innrrancti Company/Policy Number) (Expiration Date) (Name of Contractor) (Insuance Comparly/Poticy Number) (Expiration Date) (stlach additional&htc LrnoocnAry to cnchxlc rnrormatioa Pcltai &to ell oDat,d n) (<aam a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE please be aware that wttilo borncownm woo«>rplay potions to do a f a �coo err repair work on r.dwelling of aot more than throe ttaiu in which the hoaxouvcr msidcs oc on tha grounds appttrteawi theeeto arc oa gcncralYy eoc=6acd to be employes adder tbn worker`s compczss4cn Ad(GL.152,sa 1(5)),application by a homeowner for a li=5z cc Pala may evidence the legal ctahu of an employer under the Workjoes Compcmatioa Act I undetst%ad th.d a copy of this ctatcmcur stay bo forwarded to tbo Department of Im,,,bid Accidta&Offioo of Inaur*nco for the coverage va ificatioo and that f Aura to aeatre covaago under soctioa 25A of MOL 152 can lard to the imposition of crimiall Prnalties ooasisQng of a&ae of up to S1,500 40 aadoc' of UP to ow year and civil pmaltia in the form of a Stop Work Order and a fim of S 100.00 a day SIgI1Cd this -''der 1991? For&put8 useonly Permit Number Map# J Lot# Si iccnseeJPermit cc 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 G/ IF YES,describe size,type and location: 11 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DOE TO LACK OF INFORMATION. Thi: colmmm to be filled in by the Btd2ding 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 # '6f Loading Docks Fill: -(volume -& location) i 13 . Certification: I hereby certify that the info r on tai -. herein is true and accurate to the best of my k " DATE: -y APPLICANT's SIGNATi:1 --- -cam NOTE; lsyivan a of a zoning permit doers not relieve an at lionnrs burden to oompty with 4&11 zoning uiremants and obtain all required permits from the Board of Health. Conservution Commisslon. Department of Publio Works and other appiloable, permit granting authorities. FILE # FEB 2W �.. File No C� ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: Address: / f~ —Telephone: 2. Owner of Property: Address: Telephone: " / ,- 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): 4. Job Location: Parcel Id: Zoning Map# _j 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/Vadance/Finding ever been issued for/on the site? NO DON'T KNOW 4-� YES IF YES,date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW I. YES IF YES: enter Book Page and/or DDocument# 9. Does the site contain a brook, body of water or wetlands? NO 1- 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) ra � L FILE { } Id ATRIC 0fCT PERSON: 7 p PROPERTY LOCATION: MAP 13.5— PARCEL: ZONE THIS SECTION FOR-OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM MIND OITT Fee pqifi 13nil in2 Permit Filled nut Fee Pgif] Type of Constnirtion- Rernaddin2 Interior Arre�,qnry Structure �'!G THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS AM ICATION: Approved as presented/based on information presented k/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 Conservation Commission SignatA(o:)f *d* e r Date NOTE:issuanoe of a zoning permit does not relieve an appllonnt's burden to oomply with all zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Department of Publio Works and other epplioable permit granting authorities.