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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. SZ7� ;'%E�, Alterations
NORTHAMPTON, MASS. -- /> J 19 tip Additions
APPLICATION FOR PERMIT TO ALTER% � Repair
Garage
1. Location ��fi � yX -)Cft A Lot No.
2. Owner's name 's Address 3S6 Lam.
3. Builder's name
�c�Clj2<ti �, 'ZSL: n Address 2-Z/A.. 6q W)
Mass.Construction Supervisor's License No. D S f/05 Expiration Date ' Z f - r ct9
4. Addition
5. Alteration
6. New Porch
7. Is existing building to be demolished?
8. Repair after the fire
_Gar* - oil No.of-cars Z Size
10. Method of heating
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cosL- ZL)b { -c-
e undersigned certifies that the above statements are we to the best of his, her
knowled f.
Signature of responsible app,icanf
Remarks c c �uH ywh r cec
�04� P
29097
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A ass aCh"sals
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OF.RILOI1dG INSPECTION$ DEPARTMENT OF BUILDING INSPECTIONS
N® 11'` N MA 01060 212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(llcensee�permittee)
with a principal place of business/residence at:
M4w^\SX3W P-P Sot 4Nkm WJ (phone#) S2� - 13cp
(silrei/city/s�tal.eJrip) •Ql®7�
do hereby certify, under the pains and penalties of penury, that:
W I am an employer providing the following worker's compensation coverage for my
employees working on this job:
VA 'TL)AL_ F�w�C.�ao 3 -rra► °9� 3 - %D- 98
(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) Unsurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy/PoLcy Number) (Expiration Date)
(Name of Contractor) (Insuran(—_ Company/Pokcy Number) (Expiration Date)
(Name of Contractor) (insurance Company/Policy Number) (Expiration Date)
(attach additi=d shoot ifnocc=xry to it 7 infbrmII on pettalIIing to all cootrA r7)
( ) 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 aware dol whilo homcowncra who employ pcm=to do m_ ca-+ e coffiuvdion or repair work on a dwelling of
not more than throe units is which the homeowner resides or oa the grounds appurtenant thwdv are not ge icraily co=dcrcd to be
employes under the worker`s compensation Act(GL152,m 1(5)},;application by a homeowner for a Gccnx or permit may evidence the
legal clattsa of an employer under the Worker's Compomatioa Act
I undasttnd tbra a copy of this rtatemmt may be forwarded to the Dcpar twcd of 1.&L t ial Ax&a&Ofoo of Insr—for the
oovmge verification and that fail=to satire ooverabv tmdet section 25A of MOL 132 can lead to the imposition of aimiasl penalties
oomisting of a Ere of up to S1,500.00 an&or imprison of up to one year and civil pc alwes in the form of a Stop Work Omer and a
rim of 5100.00 a day against me.
Signed this _day of -Q-� 1991 For dPUtmtrd—only
r / Permit Number
`L Map# Lot#
f LicenscelPetmitice
10. Do any signs exist on the property? YES NOt' `
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 colnmm to be filled in
by the Banding 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)
# _,pf Parking Spaces
# of Loading Docks
Fill:
_(vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: -2 `C{'7 APPLICANT's SIGNATURE 'I
NOTE: Issuanoe of a zoning permit does not relieve an appl ant's burden to oomply wP4,,+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 #
U v �
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SEP 2 91991
DEPT BUILD'�`4 � � File No._��_
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address:_ 22lq P o t tut iZA Telephone:
2. Owner of Property: k Z`;�C L 0 A ya,
Address: ,3S8 e;,4 n —V—Zt0.A Telephone: �6 6 ~ Z917
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# Parcel# District(s): Q"t
(TO E FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property (7CX V A(L;c
6. Description of Proposed UseM/ork/Project/Occupation: (Use additional sheets if necessary):
ov e 41 sa I m er tr l 0,5 yA vod .S 14 i N t>L'. Ah is
X707-7
Qi,N6v
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 KN0l1' , 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)
LL FILE FILE # X962835
IJ 1; �`�� '
0291997 s�
APPLICANT/ O ACT PE N: Aal,
DENORNANIMIN MA OICLO
PROPERTY LOCATION: 36_ .,
MAP PARCEL: ZONE
THIS SECTION FMOFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM Elf LED OUT
Fee Pnid
RnildinZ Permit Filled mit
Fee Paifl l 6 r ®'
Rernndelin2 Interior
G V/
THE 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/ZONINGBOARD 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 nservat' MISSLOV,
�j
Signature o Building Inspector Date
NOTE:issuanoe of to zoning permit does not relieve an applioant's burden to comply with all
zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applicable permit granting authoritlas.
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