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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel. /S�-7-F Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
a Garage
1. Location Lot No.
2. Owner's name Address—
3. Builder's name Address
Mass.Construction Supervisor's License No. 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 appicani
Remarks
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af. � Nart4alITPOTT z
aB �asaxclltssctta
m DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building 'a
Northampton, Mass. 01060
WORKER'S COMTENSATTON INSURANCE AF t AVTT
(li censer_l pe tmi ttre}
with a principal place of business/resideoce at:
'j7373
(&un_-ucity/stalflap)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Lasl 'duce Company) (Policy Number) (Expiration Date)
( ) I am a ole proprietor, eneral contractor or homeowner (circle one) and have hired
the contractors st e ow who have the following worker's compensation policies:
(Name of Contractor) (Lnsuranc; Company/Poticf Nurnbcr) (Expiration Date)
(Name of Contractor) (Insurance Compau),/Pokcy Number) (Expiration Date)
(Name of Contractor) (Insurancti Company/Pohcy Numlxs) (Expiration Date)
(Name of Contractor) (Insurance Comparly/Policy Number) (Expiration Date)
(atladt-MT60oa1-1,d if ooccxury to inch,&-infocmitioa pc:tniaing to all md,-odors)
( am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:plcaac Ix&W-Arc that whilo homcowncn who employ perzom co do ,•r�cortnutioa'.or repair work on a dwelling of
not moro than thtto units in which the ham,,owncr r =do or oo the grounds appurtenant thereto arc oo(gcocrally ooandacd to be
employ=under tbo w-keys oomp=uiion Act(GL152-"1(5)),applicaDon by a homeowner fora Brea,&a permit may cvicl. o the
lcga!"t tus of an omployoc under tho Wockce,compcmiiioa AcL
I undaatand that a copy of this L tcmcnt may bo focward.od to the Dtparimm2 of In6is4i el ArAd�&offs o of IaAu� for the
eovaxge vaifieatioa and that fail=to scatre covcrago under soetioa 23A of MGL 152 can ltmd to tbo imposrhoa of criminal penalties
ooaiis ing of a fine of up to S 1,300.00 nndlor imprisoamcnt of up to one year end ava paxxNa in the form of n Slop Wotic Osder.aad a
fino of S1oo.o0 day&VdnA mr-
For uio Daly
Permit Ntunbes
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-NOTE-
THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER l
SOURCES AND IS NOT TO BE CONSTRUED AS AN ACCURATE
SURVEY AND IS NOT TO BE RECORDED.
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TO: UMASS/FIVE COLLEGE FEDERAL CREDIT UNION &
AMERICAN TITLE INSURANCE COMPANY
I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMENTA71ON ALL EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES,
EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
COMMUNITY # 250167
SURVEYOR: R ax'" 'F' -NOTE-
THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONSTITUTE A PROPERTY SURVEY
of -MORTGAGE LOAN INSPECTION PLAT-
�r RMDALL
NORTHAMPTON, MASSACHUSETTS
c IZER PREPARED FOR
u }35032 EDWIN C. & JENNY SPENCER GENTZLER
pS SCALE: 1 ' =40 ' DECEMBER 10 , 1992
su HAROLD L. EATON AND ASSOCIATES, INC.
REGISTERED PROFESSIONAL LAND SURVEYORS
�• -�- 235 RUSSELL STREET - HADLEY - MASSACHUSETTS
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
1 Required
Existing Proposed By Zoning
Lot size C_�J
Frontage
Setbacks
- side L: R: L: 35 f R: 1061 j S
- rear I
3U `
Building height
Bldg Square footage /00? a 1/ p, C�5"
%Open Space:
(Lot area minus bldg ]
&Paved Parking)
# pf Parking Spaces
4t Hof Loading Docks
Fill:
4 volume -& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: ( �:1��y� APPLICANT's SIGNATURE
NOTE: Issuanoe of a zoning permit does not relieve an applioant's burden to comply wit'7 gall
zoning requirements and obtain all required permits from the Board of Health. Conservtation
Commission, Department of Public works and other applicable permit granting authorities.
FILE #
F
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.�V 919%
File NO. �
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w � „ 7 T .HERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: ` \ ! Telephone:
2. Owner of Property:
Address: ��3 s\ �<<:Z��> Telephone: `A1 �K
3. Status of Applicant: Owner x _Contract Purchaser Lessee
Other(explain): \
4. Job Location: z-
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):
i Attached Plans: Sketch Plan y Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
S. Has a Special Permit/Vahance/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 # 963945
9 i998
APPLICANT/CONTACT PERSON:gAA0R,,E$$/,PIIONE:
PROPERTY LOCATION: eex-
MAP �� �� PARCEL: 4�(v Z NE�(PA�.t
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FH,Y,FD OITT
Fee Plid
lRididing Permit Filled 011t
Arr",nry �trrnrtnrr
�P
T THE�.OLLOWING 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: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
eptic Approval-Bd of Health Well Water Potability-Bd Health
!Permit from Conservation tnmissioll
///lxo
Signature of Building for ate
NOTE:issuanoe of a zoning permit does not relieve an applioant's burden to oomply with ail
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission, Department of Pub.lio Works and other appiioable permit granting authorlties.
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