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Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. ___ Alterations
NORTHAMPTON, MASS. °SU�t e �` 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location -FS �S � f in A Ie, L Lot No.
2. Owner's name f°i u�'�c 1�pp/ec Address I
tUC {
3. Builder's name ��/% ��i T, 1 n �t r Address v T l� c� C e' T f�\ /c ,
Mass.Construction Supervisor's License No.. (µ� :��i l �- Expirati Date
4. Addition
5. Alteration
6.. —ew arch !I1 @r,,� r=c l I ,�irt,,,,� c� To / 1 (� ^!
7. Is existing building to be demolish . N
8. Repair after the fire
9. Garage_ 11� I No.of cars - Size
10. Method of heating � Yl-e
11. Distance to lot lines_ 43-
12. Type of roof
13. Siding house "' ►�
e �
14. Estimated cost-
J
The undersigned certifies that the above statements are true to the best of his, her
knowlleed e`aqd/Lief. _
Signature of responsible app,icant
1 /
Remarks �
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9 DEPARTMENT OF BUILDENG INSPECTIONS I
t BUR
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WOMCER'S COMPENSATION INSURANCE AFFIDAVIT
(li cc�scclpermi Utc)
with a principal place of-buSineSSjfeSldeDu, at:
(stJr ucZty/stale/np)
do hereby certify, under the pains and penalties of perjury, that:
I am an employer providing the follollvmi g worker's compensation coverage for my
emp gees wot�ng on this job:
r G:. Ll4(2 Sc,r q-Gt s 60
ansztrance Company) (Policy Number) (Expiration Daze)
O 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) (Insu 011c:, Company policy Number) (Expiration Datc)
(NaMc of Contractor) (Insurance Compan),/Pot cy Numb-cr) (Expu-anon Da1c)
(Name of Contractorl (Laura-uce Compaay/Pohcy Number) (Expiration Date)
(Name of Contractor) (Insurance Companyipol cy Number) (Expiration Date)
(& di ad6tica2l v ct ifa�ly to i,,} inf,0 m 6co pertaining to eU ocotr on)
I l a e.sole proprietor and have no one working for m -
am a home owner- performing all the work myself.
e
NOTE_please be awl.-e the whir,homcowna3 wbo employ perrom w do mxiuica no.—, vT i oo:ar repa r work on■duelling of
not tno"thaa tbroo units is wL i h the honwowncr r,d,or m tho pfmtods apixurtcnat3 trYZCto arc oc<gcvcrally 000s.dcrcd to be
employers under tho workn's oc�aircu Ant(GL152-m 1(5))�appirra6on by n homeowner for a lice-,cc pit 0'y !ho
]cgxt resin+of an omptoyoc uod<r thn Wo'k e,Compomat�on I ct
I un&rAAx id tivt a copy of tb x riztcmcut may bo focwwr to Lb.Dtpactnxo2 of 1n6iztncJ Al dm&offs o of lawn000 for the
covuxge vcnfieatioa and that Edtl �to seatre tovernga under soction 23A of MOL 152 Cut lead to tbd i-P iOa oCcriminal pcaalties
oomisiixtg nCx fmc bCup to S1 500.00 and/or iu�o®cat of up to.0oc year end cin7 pcox1b, is the form Of IL Stop Woilc Order&M a
of 5100:00'x day LgAiait¢ic
For-dcp�uio°aly
oPcrmlt 2ltunber. rz�r t`t
Qiaturc of LiocnseclFcritiicicc
_
AM :�
26-40 to « tus
26-21" «Jn g .e
117 •
l 26-22 f«
., 26-20 35-t_
w.
ps
•3�ar f.T 141a K)e 35-131 ,3 29 .n
1SA
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a�1 SO "0 ~ '� ~144 13t�. 1 12
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c
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"a •• IFt rl 16 ,e
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T 17 Well tlAe 171.1.3 lot
�� 1.0.1) , fr.
+» 1 l ••14Qr «139 101 100•• 99. 98 97t 96
15 iSS 63 t«64 1" 11 ,sl.n w
i S6 61 62
fK7. yp I ON
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tee a K) .. w
IMAM ,ra. QJRn FIT Jb
In flat K7 Ill.. , 130 1"
,» v Ib 1b 1901 In191'4 192 193 194
on � 1. ,r 1e ' 1951 196. 197
!a U ,Oa, f i1 fM off
I sll fM11
J3 267
t »
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aa' t5! 113 1,I..e 2S9 .w
260 261 117.40
20111.. 202 2031-s1 t...) ,.q
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2 263
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79 •.�_
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:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This column to be filled in
by the Building Department
I Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks 0 r t !`-
- side J, `` L. R.
- rear 1
Building height
Bldg Square footage s I 1999
%Open Space:
(Lot area minus bldg
' &paved parking)
pf -Parking spaces
f fof Loading Docks
Fill:
4 vol-lime--& location) /V. 4� .e
13 . Certification: I hereby certify that the information contained herein
G, is true a d accurate to the best of my know^le-dgg%p���fff```
DATE: C APPLICANT's SIGNATURE �V Lwz y
NOTE: las an a of a zoning permit does not relieve an applioanVe burden to oomi ly witf)".4kil-
zoning requi manta and obtain all required permits from the Board of Health, Conservtotion
Commission, Department of Publio Works and other applicable permit granting authorities,
FILE #
goo File No.
��BUILf p3
ZONING PEMffT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
///
1. Name of Applicant: l t4r/l o , r "e
Address: �/ C, 42- �Gt e hrie /,4elephone: Y/3 --o-96 0 e 3
/���
2. Owner of Property: �`t r r �i/cc
Address:_0 kC A.,r7 -I « Telephone:
3. Status of Applicant: _Owner Contract Purchaser Lessee
Other(explain): /� I
4. Job Location:' / /`�. C`,r` G. : c
Parcel Id: Zoning Map#_ �� Parcel# OV3 District(s): _
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property iec. L.7`. I
6. Descrfi lion of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
f\ e 5��� e a7ct � �•,�I ��,ti G 7� �L e-c �a re c
kl/
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 Per arianc:e/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 ocument#
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)
i � FILE #
9�:�646 Qom/
� q TT8/CONTACT A`RLICA PERSON:
ADDRESS/PHONE:
9
PROPERTY LOCATION:
MAP 3j PAR.CEL: ZONE
THIS SECTION FOR..OFFICIAL USE ONLY:
PERK HT APPLICATION_CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FH,1 ED OUT
Fee Paid
$ nildina Permit Filled mgt
Fee Paid
Tvne of Constriction-
'New Cnn.,qtriirtinn :;22 _X-
Remodeling Tnterinr
Addition to Existing
Arre,vqory ,';trurtnre _
Rnilding Plans Tnrinded-
3 4ets nfil�Tant elan__ �� _
TH�,FOLLOWING ACTION HAS BEEN TAKEN ON THIS 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
I/
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 Cronsservati commission
Signature of Building ector Date
NOTE:Issuance of at zoning permit does not relieve an applicant's burden to oomply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
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