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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location 5-f--7 rgDi,, '�.. P yr MaeTilAn y ro v MA. Lot No.
2. Owner's name 4./C�� �4(���C-1e Address
l A�o�-i 6,f j he'i-C if2?//46. 171t Address 07
3. Builder's name 4
Mass.Construction Supervisor's License No. 3. J�'S Expiration Date
4. Addition
6. New Porch � ��
7. Is existing building to be demolished? Aa
8. Repair after the fire //t)
9. Garage A� No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost:- Sv 000
The undersigned certifies that the above statements are true to the best of his, her
knowledge lief.
• Signature of responsible app icant
Remarks
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DEPARTMENT OF BUILDDIG INSPECTIONS
2x Main Street ' Municipal Building ,
Northampton, Macs. 01060
ORICER'S COIMYENSA`Z`ION INSURA-NCE + IIDA.VTr
(hCMSc-lP rnvuco)
with a principal place of bu-iness/residence at:
. /-0
(st7r...t/ci�/stzlrJn p)
do hereby cer'ufy, under the pzaim and peaalties of per)ury, diai.
I am an employer providing the follo%vnmg Nvor'�er's compensation coverage for mti'
employees working on this)ob:
Aelv z V g*17
(Insurance Cotgzny) (Policy Number) (Expiration )
ri Zy��
( ) 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) Qnsu any Company/Poiicy Number) (Expiration Date)
(Name of Contractor) (Insu=c-- CoarpaayRolicy Number) (Expirm6oa Due)
(Name of Contractor) (Insurance Company/Policy Num_bzr) (Expiration Date)
(Name of Contractor) (Insurance Compauy/Poky Number) (Expiration DaLe)
(eIIach additionj dbo irnooc:ury to tnfo,:J ioa par_imng w all mdr-._C.on)
( ) I am a sole proprietor and have no one worming for me.
( ) I am a home owner performing all the work myself.
NOTE:plena-be aware that vihilo boa=wocn%tbo employ pc mow to do—iui—Occ coonuxioa-or rep*.r work oo a 6-- iag of
aot aK"t1Ln tbrvo units is tvlvch the bomoowocr remdo oc oa the srouods rppurtcaaat tbrndo ere oo(gcocrslly considcrcd to be
--ploy—under tbo wozkcrk o=P=5ation Act(G LI S2-=1(5)�appliaL600 by a bommwncr for a liccwc or permit may evid—the
legal rtatus of an employer uadectho Wo�a compoos4ioa AcL
I uoda-z�d that x oopy Oroais mtuami may bo focwnrded to rho Dopertmcot orindL-,triel Acci OLIioo of Iavxanoe for dw
cov=a verificstioa and that failure to secure oovcrngo undo socuoa 25A of MOL 152 can kid to tbd lmposi6oci of aiminA pcaaitics "
comistiag of a•5ne bf up to S i,5oo.00 and/or bnprrsovmcat of up to one year and and pcmtda in the form of a Stop Work Order and a
5no O(:S 100.00 a day a&Lilxa the
Signed ��t�► day of 311 )!d . 1997 For 6cpatma3al uao oory
Permit Numbcr
Mao Lot#
S i/e Jpermittcc
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: Gc1i �/ G1��� �f��� ,ti
r
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This col— to be fit ed in
by the Building 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
f of Loading Docks
Fill:
4 vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my know dge.
DATE:
: APPLICANT's SIGNATURE A
NOTE: Is uan a of a zoning permit does not relieve p ant's burden to comply with .aIi
zoning uiraments and obtain all required perms from the Board of Health. Conservation
Commission. Department of Publio Works and other applioable permit granting authorities.
FILE #
JUL 3 U Q91
File No. /
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: l}
Address: LAfle OzQz5Telephone: 4//3,S2,7(fVif2
2. Owner of Property: i< L SU H
Address: l X410 VCS I 'M�"SS Telephone:
3. Status of Applicant: Owner —el—Contract Purchaser Lessee
Other(explain):
4. Job Location: S'rQ�(U /�V r� �t)�k�A'M- -TO tJ ; ✓��•
Parcel Id: Zoning Map#.. S, 3 Parcel#_ i r District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
S. Existing Use of Structure/Property C—CD'M'M Ce—C_ �--
6. Descri lion of Proposed U e/Work/Pro'ect/Occupation: (Us additional sheets if necessary):
l �19� rvc<
7. Attached Plans: V 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 V ia DON'T KNOW YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO—\// KNOW YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO V/ 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 # 12609
3 Ji � �p��
JWPPPIKNT/CONTACT PERSON: AV
ADDRESS/PHONE: � 6'07 3
PROPERTY LOCATION: a Imo°
MAP o? PARCEL: ZONE d j�-
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
70NIFNG FORM FRIED OUT
Fee Pairs
Buildin2 Permit Filled ntit
FP; Pain c4 7/
Type of Constuirtion-
Accessory StrnrturP
L� v,i
THE LOWING ACTION HAS BEEN TAKEN ON TIES APPLICATION'
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 Conservat' Comm'ss'
Signature of Building Wector ate
NOTE:lasuanoe of a zoning permit does not relieve an applicant's burden to comply with all
zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authoritles.
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