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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 2;2�Z -y 775— Alterations
NORTHAMPTON MASS. &1 "� �� 19 1 �J Additions
' APPLICATION FOR PERMIT TO ALTER
Repair
i Garage
1. Location / n %'= Lot No.
2. Owner's name ) > Address
3. Builder's name 1 � �" ' '1 . ? Address `� )4 V
Mass.Construction Supervisor's License No. (!T Expiration Date
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 `` - �✓^ °�
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,icant
AV
Remarks
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9{ VORTHAMV9 I a f arf1 allt ton
31997 � 1 .9 BUILDING IPJS E DEPARTMENT OF BUILDDIG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
-CVO R'S COMP 'ITON INSURANCE AFFIDAVrr
� (Li�nscJpermittt:c)
with a principallace of4es idence t
y �� � � phone;{) Z 7 V - 40lz_s—r�t/cido hereby certify, under d penalties of perjury, thy:
O I am an employer providing the following v.'or'rer's compensation coverage for my
employees worling on this job:
(Inszmanee Company) (Policy Number) (Expiration Date)
(�} I`am a sole proprietor, eneral contractor or homeowner (circle one) and have hired
e contractors llst e ow who have the following worker's compensation policies:
(Nome of Contractor) Qnsu=cc Company/Policy Number) (Expiration Date)
(Name of Contrzctor) (Inszlrancz CompanyRolicy Number) (Expiration Date)
(Name of Contactor) (Insurance Compauy/policy Numb,--r) (Expiration Date)
(Name of Contractor) (Insuranct- Company/Policy Number) (E)piration Date)
(rtiath-kli6oc�d rboct if nocxi, yto iac}>dc informaa,o pert,u to all oodrn c'on)
t I am a sole proprietor and have no one wor-Eng for me.
( ) I am a home owner performing all the work myself.
NOTE-please be awatc that v halo bomcovn>=wbo employ perr.=to do�n-dw,nce o==uc600 or rcp1Q work on a dwelling of
aot more than tbroo units is which the homeowner raid,=oc oa the gound3 appurtcawt tb=to arc not gcoavlly coandcrod to be
cmplayrrs under d-wv&-'I.00Prnuiioa Act(GL152,=1(5)x,application by n bomcowncr far a license or permit may evidmoe the
legal status o£aa employee undcrtho Wociccla Compomation Act'
I uadctztsad that a copy of this eizt—re may bo forwurdnd to the Dcpertmmd oflndu=l-id Aoddca&Office of Inaranoo for the
coverage vaiscatioo tad that failure to amore covcraso under sowoa 25A of MOL 152 can teed to tbd imps OQ of airmail P—d6c,
oo=tmg of a•fine tf up to S 1,500.00 and/or kapri=o�of up to one year and c i pcmitia in the form of it Stop Work Ocda nod a
fine o(5100.00 a day cgninA m--
Signed thjs day o . - 1997 For dV=tXCOWU—ooly
Permit Number
tvfap'./ Lot#
Signature Of iocnscdPcrmittoc
10. Do any signs exist on the property? YES NO fz)c
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 —7— to be filled in
by the Building Department
I Required I
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minas bldg
&naxyed parking)
# f Parking Spaces
f rof Loading Docks
Fill:
(vol-ume--& location)
13 . Certification: I hereby certify that the .informatio contain herein
is tru d accurate to the best of my knowledge.
DATE: G��1' , C 42-7 APPLICANT's SIGNATURE
NOTE:-Issuanoe of a zoning permit does not relieve an ap oant's burden to oomply with~oil
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 #
9 OCT 31997
DEPT OF BUILDING IFJSPEil �aa5 s5�
NORTHAMPTON ldlA D1C1qt�_ File No.
ZONING PERMIT APPLICATION (§10 . 2
P E OR T ALL INFO/ ION
1. Name of Applican
Address: � /V ep oz ` 611
2. Owner of Property
Address: ,/GS�IZ .eT' ; r U_ 'Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: 9l &64L 6
Parcel Id: Zoning Map#!,(—,I Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Desc ' ' n of Proposed se/Work/Project/Occ o (Use qdditiopal sheets i c ssary):
�ccc/
.,
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)
y� , FILE # ��%-.2�.�•r�,J
OCT 31997 = .J
APPLICANT/C- NT CT PERS N: Zl��Yk
DEFT t�'� 'E. yl—
N ,p
PROPERTY LOCATION: le — �
MAP---,_, PARCEL: `'? ZONE
THIS SECTION FOR.OFFICIAL USE ONLY:
PERNIIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM Eff LED OITT
Fee Paiti
]Rnildin2 Permit Filled ovit
Ee� Paid
Tyne of Constniction-
Rernndpling Interior
THI KLLOWING 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/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § wlZONING 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 Conservation missi n
� G
Signature of Building 1.W Date
NOTE:lssuanoe of a zoning permit does not relieve an applioant's burden to oompty with all
zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appiloable permit granting authorities.
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