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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. r/�� Alterations
NORTHAMPTON, MASS. 19_ Additions
APPLICATION OR PERMIT TO ALTER Repair
a
Garage
1. Location c Z S (tA tU S T)A-�.- Mm.Ui Lot No.
2. Owner's name njW U&R Sl-�f� Address" Silk1 Sr, , A,GhWA�A. MN
3. Builder's name K� . PL4 CO Address Zs CAl&A
Mass.Construction Supervisor's Lie se No. Q�,., O�2 Expiration Date Ila 1 o'12-
4. Addition C mck mbi U.'!" .C9Ny �cLA�C� t4o1k 1nXM
5. Alteration
6. New Porch VAG
7. Is existing building to be demolished? 14.b
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating S
11. Distance to lot lines 1 501Frj— LEFT-. �'�
12. Type of roof RU
13. Siding house
14. Estimated cost:-
The u ersigne c ies that the above statcmcn F t of his,
knowledge pd belt EDWARD q�yG
X J. m
° ryl FARY
S� Rat re of respo ible rt{11336 o Q
°F GIs t9,
Remarks
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m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street e Municipal Building
, e
Northampton, Mass. 01060
WORZCER'S COMPENSATION MSURANCE AF MAVIT
(li�i�/peruii etc:)
with a principal place of business/residence at:
'Lt J SK y,e 11K•{ 0 lD "7°Z r 7�-I D
do hereby cer(ify, under the pains and penalties of perjury, Lha;.
( cII7 an employer providing the following Nvor-�c 's ccmpensat;oD cove 2ge for my
employees worming oo taus)ob:
T2 e- TM I I e-,L r-'-s K q q4 -V h ?-lq,?
(Insurance Company) (Policy Number) irati Date)
( ) I am a sole proprietor eneral contracto ,or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) QInsurancz Company/Poky Number) (F-cpim6on Date)
(Name of Contractor) (Insurance Compaay/Policy Number) (Expiration Date)
(Name of Contractor) (Lagwanc-- Compauy/Poticy Number) (F--piraaoo Date)
(Name of Contractor) (Iasuranc-- Company/Poky Number) (E)cpiration Date)
(znic�additioo.�f c}wet if000c u-y to oc.`�dc iafocmi!ioo pcZising w.1t oma-xvn)
( ) I am a sole proprietor and have no one working for me.
( ) I am a-home owner performing all the work myself.
NOTE_please be aw�tc the w6ilo bomcawncn wfio employ perrom to do cow ti oo'or rcpau work oa a d—Uiag or
not mocc th—tbroo tails is wbicb tbx bomoowocr raido or oa the gourds Tpidmu t tb=o ere cc(golly oomidcod to be
employ—undo tbo--iccc4 p ctjm Ad(GLI S2.331(5)�applicL6oa by a bomoow=for,Gcrn3c cc permii may cvidmoc the
legal eisasa ofaa r�sloyer twdertho Worico�e Compomatioo.Act' .
I::Ada t.:sd for sky cf this rt tcmmi may bo focwerd+d to tSe Dope t x d of Izduxri d tiocdma CJf .o(laAuaaoo for the
oovcrxgc vcrificsiioo and that failtrtr to cc�trc oovc�nbrs tadcr scuioa 23A orMOL 152 an aced to tbo impozitica oCczimiasl pcaalbcs '' '
000itsaag ora-ne orup to Sl,5oo.0o mNoc imprisommeat ofup to ooe year,ad ava P=dtia is the form ora Stop Workocdcr and a
findoCSl00.00 adiy sgsumt.t�
this aZ _ dayof 199 7 nly
Pcimit Numbc r
Q 7-7-5N 3. mapY Lot 9
Sig)aahsc c iocnscc,Pcrrodu=
10. Do any signs exist on the property? YES V NO
IF YES,describe size,type and location:_ ktEA` ITKIL lw llcl �SQ
Are there any proposed changes to or additions of signs intended for the property?YES NO
IF YES,describe size,type and location: l ,M l� yj ISi�� � `�
u
?`� � �l^t�?t
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This cola to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size —:sP
Frontage
Setbacks 2
- side L:-50 RA-60 L:—C;3 R: l3 Q
- rear
r+
Building height Fr t3 F-aT Mtcn�
Bldg Square footage 24 44 2
%Open Space:
Lot area minus bldg
' &paved parking)
0f Parking Spaces
of Loading Docks
Fill:
Avo3.-dme-4 location)
13 . Certification: I eby certify that the information, contained 4erpin
is true and acc ate the st of my knowled^-- "
D7E: PLIC SIGNATURE /
NOTE: Iss ano o a'zoning permit d es not relieve a applioae u en to oor*n1y► witf),Apll-
zoning uirements and obtain all required permits from the of Health. C+oinservtotion
Commission. Department of Publio Works and other applicable ermit granting 0?ithorittss.-
FILE #
Fi 1 e No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: V}LPN;kt�, us. A
Address: Telephone: -1 o 7 6!2�a X0-1-70
2. Owner of Property: 4US 04 U t%1"��
Address: 6 bt> -5j LVkk'S t , M h Telephone: 4A3 0 78)b o3 72q
3. Status of Applicant: V 'Owner Contract Purchaser Lessee
Other(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 ►a1C)� CSOPON j
M FASMUMA-. ar
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
Aw m'-C j (VV7 i
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 11- � DON'T KNOT: YES IF YES,date issued:
IF YES: Was the ermit 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 I//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 # 96 ?G95
AUG ONTACT PERSON:
ADDRESSER NE:
Pi6kKT-' CATION:
MAP_ 11f PARCEL: ' ZONE 9-/
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQU RED DATE
ZONING EORM MIND OITT 75
]Riiilding Permit Filled Out
t
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION-
Approved as presented based on information presented
V Denied as presented:
Special hermit and/ Site Pla N equired under: § /0.�/ Sao sc�F f.°,e Sr!�JCr
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 fro Coons�ervati C mmissi
Signature of Building Inspector Date
NOTE:Issuance of a zoning permit does not relieve an applloant's burden to oompty with all
zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commisslon, Department of Publio Worlcs and other applicable permit granting authorities.