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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No._/—� — ' Z Alterations
NORTHAMPTON, MASS. �/ /r" 19 ;i'� Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
I. Locations sZ L �'1 �T� '��� �� Lot No.
2. Owners name l✓d N o a m, Address i'A
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
r
4. Addition e
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
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible app icani
Remarks
m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Muss. 01060
WORxtcR'S CON PENSA"Xloi`I INSURA—NNE AFFIDAVTT
(li censedpermi tire}
with a principal place of bu-T'nessJresideoce at:
I" /:a-eC tF !��C tJ UK_ ,' rV W, honet�) S - I
(str tJci ty/Swrla P)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following woikt-i's compensnon coverage for fny
emptoyees workirlg on this job:
(Tns ac—, Company) --- ---- (Policy Nu_nE'--r) --- - (Expiration Date)
( ) I rinl a sole proprietor, general con'cr-actor or homeowner (circle one) and have hired
the contractors listed below who llave the followiflg vrorkei's compensation policies:
�VE1II.r of Con. i�1 C(�[� (Ln„_ ;._�� �_,Glll����,T11�OL'l:j �IuSIl'L•;.r) l-_iJ�.dC10Ct l)�,iC)
([d�unc o Contt;clor) (In�itr.r,c.� �;ou�pan�/F'o!ict ttui,.t,..r} (T�p<<2�oa Da_(e)
--(Name of Contractor) (LM-ttranC� Compaa)•[Pohcy Numh--fl (ExpLm,bon Date)
(Ilatne of Contractor} 1"lumber) (EX-piraboo Date)
(nttadi zGditic�xl sbx.!iFnccx-iry to u�chu�in(crtniiioa p..--trsav�E to dll cc�ira��r�)
O X ari a sole proprietor and have no one working for me.
(,(am a home owner perforinuig all the work myself.
NOTL-pleat be aw : dut v Hilo hcmcrnmcra w' employ p���w do ntr.,� c,a uctioa'ar tcy u wo k on■d.vclling of
not sneXn than thi-emits is trhiet th, IIou p{kk pon2;11 oQ to be
bomoowncr rcdcs«oo Lb, ads a n.+ai thGCtn uc ooc gcocrAtlY
employers under tb0—&-'I mQI�,ens c.Act(GL1 52-�1(5)�application by a hootzorvncf far e 6=,a Pte'n may-id--Lb-
1c-P1 rt-t”ofanPloyee under thn Wotkeela Compem.Lioa Aa-
I undcrzL�nd th,t a copy of thiv ztYLcmcat sn.y bo forwarded to tbo�cp°r t of In 't'i Ax d Qfrioo of lasc.nn�Ix the
--9c vrti6c iioo and that Edm c to stater w cr under suction 23A of MQL 152 can!r d to tb"imPasrtioa of aiminsl Pcualticn
of,i foe of up to S Q00.00 andfoe uu¢eoonmeai of sip to one yrar e.,d.ava pcn>lt o in the form of&Stap Work Ord«.ind a
lino
6(:s 100.00 tt dsy agAiisit aiG
For-dcQutma3rd wo-I-f
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10. Do any signs exist on the property? YES NO
1 v;�
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 cols to be Pilled in
by the Eu97d4ng Lkepartmen t
Required
Existing Proposed By Zoning
Lot size G X . 0
�t
Frontage p �
Setbacks r �-
- side L: R: L: // R:
- rear i
� l
Building height i
Bldg Square footage y
%Open Space: J�
(Lot area minus bldg
&paved parking)
pf Parking Spaces
f of Loading Docks
Fill:
4 vol-time--& location)
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13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
_1
DATE: ��/l��� APPLICANT's SIGNATURE
NOTE: lssunnoa of a zonin permit does not relieve an oant's burden to oom wlt
9 P ply
zoning requirements and obtain all required permits fro a Board of Health, Conservation
Commission, Department of Publio Works and other appliooble permit granting authorities.
FILE #
File No..
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: i4 Yin y�J v v IT7 511j
Address: 7— �a,�L.�� � '. Telephone: 5
2. Owner of Property: �r� � , r�0� s� /�d �✓ ��,
Address: S-1 f U��<=�1— �=��-� ice'GC Telephone:
3. Status of Applicant: ✓Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: S ��'C�` ' ` f✓��
Parcel Id: Zoning Map# Parcel# District(s):
(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):
Z ' ,X/L�- /' S)I-&-D
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 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 # 963664
.III
APPLICANT/CONTACT PERSON:
ADDRESS/PHONE:
PROPERTY LOCATION: s;:52- 1 ---I&Mdj���'?
MAP PARCEL: 1/-/ ZONES, Za
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION_CHECKLIST
ENCLOSED REQUIRED DATE
70NING FORM FULED OUT
Fee Paid
Building Permit Eilled Out 25
Fi-e Paid
Arri ssnry StrnrturP
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
�� Approved as presentedfbased 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
of Health ' : Well Water Potability-Bd Health
.
Permit from Conservation C mission
Signature of Bui g Insp Date
NOTE:Issuanoe of a zoning permit does not relieve an appltoant's burden to oompty with all
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commisslon. Department of Public), Works and other applionble permit granting authoritles.
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