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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location Lot No.
2. Owner's name Y v Sc P-* Address—
3. Builder's name dti ` Address
Mass.Construction Supervisor's License No.�j_//ZY 1 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 �,,e++
13. Siding house
14. Estimated cost-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
ZI
lgnature of responsible app,lcant
Remarks
' O��ttA1 f p�Q a
} Crx
, ox#1 ttnt ton
3 31997 1
BAissachtrscIII;
� g
DEPARTMENT OP BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S COMTENSA'nON INSURANCE Al t AVIT
(li�nscJpermi ttr�)
"ith a principal place of business/residence at:
(siz�t/c�h' np)
do hereby ceru ,, under the palms and penalties or perjury, ffi i.
O I am an employer providing the following vror'r_er's compensation covem-C for My
employees wor-LiDg on this job.
(Insurance Company) (PoLicy Number) (Expiration Date)
( ) I am a sole proprietor, general cone-actor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) Qnsuranc-- Compau),/Pobcy Number) (Expimtion Date)
(Name of Contractor) (Insurance Company/?abcy Number) (Expiration Date)
(Name of Contractor) Qn_s- r C-- Compauy/Policy Numbu) (Expiraioo Date)
(Name of Contractor) (lasurancz- Company/Poky Number) (Expiration Date)
(P—rh addition l rbocc if noccary to iD�inform■loo pert,�w all oodrrCOn)
I am a sole proprietor and have no one working for me.
( ) I am a-home owner performing all the work myself.
NOTE:please be aware thzt wbilo bomcow wbo cmploy pcxzom to do�inir=:�oowt-uc oa-or rry2a work on a duelling of
not moca than tbcoo twits in which the bomooavcc tcidca a<oo tba$7vuub ippu[tcawt tburto att not golly oo=Wcrcd to be
cmploym under tba workcz4.00mpca"iioa Act(G L152sa l(5)�application by a bomeowncr fora G«ssx cc pormii may cvidm'-r ttx
Iegsl etatna of an cuployee undertho Wockces compoosalioa AcL
I un&raAnd tlui a copy of tbia eatcmcai may be fotwardnd to tbo Depa uncad ofLn&u el A=d=&Ofsoo of Lwumoo for the
covaxgc verification and that fa:du=to tccnrc covcrago twdcr S,0 x oa 25A O(MOL 152 can!rs d to tbd impositioa of criminal pcaalrica
oomisQag of a fmc of asp to S 1 X00.00 aa&or inapt ooauxnt oCttp to oa year and avaT p®ltin in the form oCa Stop Wocic Ocdcr and■
fiW 005100.0o 1 day lVda"me.
{'
Signed this rj day of 1997 For dcputm�lu,00aly
f Permit Number
Lr►-
map-4 Lot#
3ijuab=of Li ctmitt=
10. Do any signs exist on the property? YES NO 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 column to be filled in
by the Banding 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
' &paged parking)
# o, f 'Parking spaces
f rOf Loading Docks
Fill:
_(vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
Gj is true and accurate to the best of my knowledge.
l'D?IIE: APPLICANT's SIGNATURE k , �
NOTE: Issuanoe of a zoning permit does not relieve an applioant's burd to oomply wH4''4111-
z9ning requirements and obtain all required permits from the Board o Health, Conservation
Commission. Department of Publio Works and other applloable permit granting authorities.
FILE #
2 31997
File No. �
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 41XIi4,-,A4 �
Address: Telephone:
2. Owner of Property: 4%,/).tJ
Address: ,f �;��� f�,l Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
,[7
4. Job Location: 0 .,,cam. 1,za
Parcel Id: Zoning Map# Parcel# /_ District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property —.-1�i { "R�-Q
6. Description of Proposed UseAfVork/Project/ cc pation: (Use additional sh ets if nec s aryl____
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 r/ 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)
FILE # 962580
JUL ? 3M :
APPLICANT/CONTACT PERSON:
ADDRESS/PHONE: r
PROPERTY LOCATION: 1 CZ — ` 2c'��2 �( �•rry�_.,
MAP 3 ( PARCEL:_ c�/7 Z
THIS SECTION FOR-OFFICIAL USE ONLY:
PERNIIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FTT.T ED OUT
Fee Pahl
}3i ilrling Permit Filled not
Fee Paid ,rC S—
Type of Cnnstriirtinn-
New C'nnctriirtinn
Remn_ delina Tnterinr
Addition to F'yktina
Arre„ory Structure
r
Owner/Orrul ant Statement T,irence
3 Set, of Plane /Plnt Plan
T> 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
Septic Approval-Bd of Health Well Water Potability-Bd Health
_ 1 fr o�v n on
Signature of Building Inspector / ate
NOTE:Issuanoa of at zoning permit does not relieve an appiioant's burden to oompty with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioabie permit granting authorities.
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