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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 22V-- Alterations
1 NORTHAMPTON, MASS. l_ c-21 19 Additions
APPLICATION F R PERMI TO ALTER Repair
Garage
1. Location ��C -.. i c�7 -C Lot No. /
2. Owner's name fi f t. Address
3. Builder's name ! d Address,/
Mass.Construction Supervisor's License No. C-S l-24-—�L Expiration Date/
at
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 ztk
13. Siding house
14. Estimated cosL- 0
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible app,icanl
Remarks " -(/ ��
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B p� 31997 nx#I ttnrnrr
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{° F��[R�/n F 81SiL11�"i� DIPARTMEHT OP BUILDING INSPECTIONS
1vl' tt`I YN57b if A„,a,...i...•
.. 212 Main Street Municipal Building
Northampton, Mass. 01060
f�R'S CO ENSATZON )NSURANCE A
(Ii censc^Jpermi ttce)
with a principal place of business/residence .t:
!t 1 hone ) --
(strz^t/ci ty/staid=p) G{ ?
do hereby certify, under the pains and pen?16es of perjury, thai.
O I am an employer providing the following vror'r er's compensation cove:-age for my
employees worming on this job:
(Insurance Company) (Policy Number) (Expiration Date)
(iI7le a proprieto general contractor or homeowner crcle one) and have hired
contracrs listed below who have the fokwiog workees compensation policies:
(Name of Contractor) � C_- Cornpany/Pobcy Number) (Expiration Date)
(Name of Contractor) (Insurance Conpanyi?olicy Number) (Expiration Date)
(Name of Coau- tor) (Insurance Company/Poticy Num_bzr) (Expiration Date)
(Name of Contractor) (Insurance Company/Poky Number) (Expiration Date)
(inach additioml sheet ifnooc ry to ij ch infixm>_aoc pertniu ng w all negation)
�40 am a sole proprietor and have no one worb-ing for me.
( ) I am a.home owner performing all the work myself.
l•IOTE:Plcnsc be aw c tbzt wtnlo bomcowncra wbo caaploy Paroas to do�ireM3D=matrUCtion'or repair work on.dWdt of
not mote than thnoo units is tvtaiclz the bomoowocr asides cc oa the gottnds zppurtcwot then ceo arc no(gcocrvlly oowi c and to be
employers under tho workcr`i-won Act(GL152ts 1(5)),applita600 by a bomoow=for a Gecwc oc permit may cvidmoc flat
1cg11 rth.of an eavloyer uadcr tho Worlcod.Compooa.tion Ar L
1 understand dX4 x copy ofthu Cbr.mc:n m.y be forwarded to tbo D",tr i oflodurrial Aoei&o&Ofoe of Ia xu.non for the
covaagc vaificstioa and that failtmc to Sc=ot covcrago tmda soctioa 25A of MGL 152 can lmd to tbd imposWoa of criadwl pmaitics `
ooqu3uns of a-tax of up to S1,500.00 aadror imprisonment of up to one y=and civil pco ltia in the form or n Stop Work Ordcr and a
fim 0(5100.00=:day tpiml me-
S tgn _day f;
1997 Foe dCP=taX39l t.,o 00ty l
Permit Number
Maps Lot#
Si of Li tto-_
10. Do any signs exist on the property'? YES NO I;
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 MAST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This colu= to be filled in
by the B=ld=g Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks =front
side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
Lot area minus bldg
&paged parking;
# of -Parking Spaces
frof Loading Docks
Fill:
-{vol-ume--& location)
13 . Certification: I hereby certify that the information contained 'erein
is true ad accurate to the best of my knbwl,�t e
DAPS= _ �f :, APPLICANT'S SIGNATURE G! ,
NOTE:: laounnperm it does not relieve an app ' ant's burden to oompty wittAy$ll
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_d
199 rc`'!�"�•
OAT 3
//
Fi 1 e No 9& e�_4
T ZONING PERMIT APPLICATION (§10 . 2)
P TYPE OR IJFRXUT ALL INF RMATION
1. Name,of Applican ' .1 -�-
Address: Telep one: p ��P�,. 3 ;
2. Owner of Property: ACZ2�:4Z 5 r1l L Oa 7W 4r2
Address: -- ---Telephoner
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): 1
4. Job Location:/ ✓ L�
Parcel Id: Zoning Map# ' Parcel# District(s): 6
(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):
1
7. Attached Plans: Sketch Plan Site Plan d
Englneere /Surveyed s
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special Perm it/Vadance/Finding ever been issued for/on the site?
NO DON'T KNOW 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)
FILE #
LIMA CU T/ T PERSON:
_. ► A C
n.ADIlS1PHONE' V--'>l -
PROPERTY LOCATION:
MAP 35 PARCEL: 43 2 ZO TY5
THIS SECTION FOR-OFFICIAL USE ONLY:
PERA UT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FH,T,FD MIT
Fee P-gid
Building Permit Filled mit
.Remadeling Interior
Addition to Existing J9 t2
-ISets, of Plan, I Pint Plan
2�
THBELLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION'
✓✓Approved as presentedibased 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
!P 't fro Conssry C on
Signature of Building Wector Date
NOTE:Issuanoa of es zoning permit does not relieve an applicant's burden to oompty with ail
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applicable permit granting authorities.
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