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Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
/ Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
1.
a Garage
/�/r Lot No.
2. Owner's name ��i'^ `1c� c'- �'�f�.'� - � is <, r Address - � �e J-r-) l�X/ r-t 40.16 /`���,
3. Builder's name ��l�!> /cl�� / l y � r .S Address i (/ -� lv /X- r=� f
Mass.Construction Supervisor's License No. C// Expiration Dated
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 we to the best of his, her
knowledge and belief.
Signature of responsible app,icant
�Remarks 4C'
♦ �-�itA�fp�,
�0
6 FEB 1 8199nasaxchnsct.ta
m DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building '% y
Northampton, Mass. 01060
WORZCER'S COMPENSATION MSURANCE All t AVIT
(licenser_/permi ties)
with a principal place of busmessJresidence at:
-(phone-') 1-1�3
(SU-C. city/statfjzip)
do hereby certify, under the pains and penalties of perjury, that:
O I am an employer providing the following worker's compensation coverage for my
employees working on this job.
(Insurance Company) (Policy Number) (Expiration Date)
( ) 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) (Insurance Compauy/Policy Number) (Expiration Date)
(N) e of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insur-an� CompaoyiPoticy NuuiL-�--r) (Expiration Date)
(Name of Contractor) (Insurance Company/Poky Number) (Expiradon Date)
(anach additional dh-c if nooc=-ry to inci,d information pertaiuing to all ooatr¢cion)
( ) I am a sole proprietor and have no One working for me.
( ) I am a home owner performing all the work myself.
NOTE:plcaac be aware th:t v tsi]o hoa=woaz who cmploy pasons Lo do mxkdcwzct,oxr�trudion or rcpair work oo►dwelling of
not an"than throe units in which the homeowner ris&3 or oc the wounds appustcawi'!xrdo arc Dot gaman oowidcrcd to be
auptoym undo tha v oriw`s oompcnsatioa Act(GL.152,rs 1(5)�application try a homeowner far a Gcc—oc Pama maY the
legal rubm of an employoc undor the Wockcla Compaosatioa Act
I unda:taad that a ooPy of this=raicmcar may bo forv`nrdod to tba Dcgn to of Indiutrial A.&.&Ol5oo of lasur•aoo for tba
covaagc wnficatioa and that Elimr w cccurc oovcrago under socuon 25A of MOL 152 can lead to tba iwpo On of criminal pcnall;ci
oomiAiug of a fine of up to S1,500.00 a"00f unPrisoamcnt of up to one year and civil pennon io the form of a Stop Work Order in a
Eno o(5100.00.day tga inst mc-
Signed this _day of j 1199J For dcputaxvtnl trio oalY
Permit Number
Map# Lot#
Signahuc ofLicenscdPcrftdU=
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 MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This cols to ba filled in
by the Buj2ding Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paced parking)
# of -Parking Spaces
# rof Loading Docks
Fill:
-(volume -& location)
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
DATE: 2 /'�j��� APPLICANT's SIGNATURE,,
NOTE: lssuan a of as zoning permit does not relieve an applioant's burden to oomply v✓it4 all
Czoning raquiraments and obtain all required permits from the Board of Health, Conservation
ommission, Department of Pubno Works and other applioable permit granting authorities.
FILE #
FEB 1 81998
Fi 1 e No
__... _ ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: I� 4N l�'")ir
Address:�1 �` ' l�{ ��'.Ti, Telephone: y13 °.5r -el
2. Owner of Property: 41 -s rJ c ;e e4✓/� - ICJ /�t'S lQ
Address: 5-7 A*e 'o>' Telephone: Z2113
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: _
Parcel Id: Zoning Map# Parcel# District(s): U
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed UseNVork/Project/Occupation: (Use additional sheets if necessary):
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 bee 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)
E i FILE # 963218
�
FM 1 8 ,1998
PLICANT/CONTACT PE 7 N:
'-ADD�SS/PHONE: �
VPROPERTY LOCATION:
N AP lP PARCEL: LS'`f ZONE l �
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM MLEII) OUT
Fee PAid
Building Permit HIM nut
-Fee Pnifi
Addition t�Vyiqfinz C)
e/
eta a ✓-,
TFIE,jWLLOWING 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
Septic Approval-Bd of Health Well Water Potability-Bd Health
Permit from Conservation Commission
Signature of Building ectoE:. Da(e
NOTE:Issuance of a zoning permit does not relieve an applioant's burden to comply With all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Conlmiselon, Department of Public Works and other applicable permit granting authorities.
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