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39-234 (2) a 2 70 'v < A. rn v c o Z m 00 a 3 C Z tm7 C: o c vo 'p r" Z O m a � A Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.'`j 4J n 5 Alterations NORTHAMPTON, MASS.__ _) A1,VZeS7 lg Additions APPLICATION FOR PERMIT TO ALTER Repair Garage 1. Location jQ1Aj, oau,0 <fn1Z,"_7z Lot No. 2. Owner's name/a1?1- �; -� GCJ� LEA Lk)---P Address c)11 ,aZ,Q ylo Xj Q e©—#2d 3. Builder's name hby) bill- Address Po, tq) 1FPpS M11 Mass.Construction Supervisor's License No. Expiration Date 4. Addition 5. Alteration ST/?J LQ .:x,42 Sr5 c;!�a or,./ -r c.2n-- & 1,46e— A SS a� 6. 4+Iow2orch Ar_7,51 P,/<:;,,� 7. Is existing building to be demolished? 8. Repair after the fire 9. Garage .��S .z�C�1 ��/ No.of cars 2 Size Zzf X 10. Method of heating 11. Distance to lot lines 12. Type of roof,.C1 13. Siding house &fet22 /2 g:";12 14. Estimated cost:- The undersigned certifies that the above statements are we to the best of his, her knowledge and belief. S arure of responsible app.icani Remarks O O afi .g Crzf� ,f 'Warfijaillp f nn . BQ ' �&sst<chtrsr(lt DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building Northampton, Macs. 01060 WORrCERtS COMTENSAITON INS RA_NCE < AVIT Nper-�t�) with a principal place of.busness/resideoce at: (phooe;r) 44j l.5 (strr h1521rJz),p) do hereby certify, under the pains and penalties of perjury, thai: O I ;-�m ao employer providing the following ..,or-�er's compensation coverage for My employees worl,:�ng 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) QMAU-any Company/Policy Numbct) (Expiration Date) (Name of Contractor) (Lasurancz- Coarpa❑yiPo!icy Number) (Ex-pira6on Due) (Name of Contractor) (Insurance Compaay/Policy Number) (Ex-piratio❑ Da1c) (Name of Contractor) (Lasuranc:�Compauy/PoLcy Number) (E pirado❑Date) (etliCh additioml rboet if no�to cxx!i>dc infocmiti oo pert:iauig to.11 oea:r-won) Ike I am a sole proprietor and have no one worldng for me. ( ) I am a'home owner perforrlung all the work myself. NOTE_Plca.sc be aw:Lrc tbid wbilo bomcov xrs wbo cmploy persow to do=*,+••,�cowJ ioa•or rcpaa work oa i d—dll or Got mock th_n tbroo units is which the bomoov% C render or on the gourds Wutcuwt therdn en not grnCrally oomidcrcd to be cmPloycr3 ttndcx tbo ms`s p=Paa%4oG Act(G L152.zz l(5)j a ppltea0on by&bomoowncr for a liecwc cc permd may cvidcnoc the legs!rtka of as employee under tbo Workoea Compoasal Act' i uo&ry smd d)at a oopy of this azatcmmt may bo foewerded to tbo Depwt=cS ofLsdai el Aeodm&o fioo or la urn for tba covaxgc vcri ic3tioa oad that fnilurc to accu x covaxso undo sodioa 23A of MOL 152 cra kzd to the imposaioa of criminal Pcnalflcs eoasisfiag of&Fme bf up to S 1,500.00 and/or imlxizoc me ofup to ooe year acid civil penalties in the focm of a.Stop Work order and a find o(:S 100.00&day IzAiust me ' Signed this day of S/, 1997 FordeP=tMv=0,r u—only -- Permit Numbcr M20 Lot 1! Signature of ioc:s.c crtnittcc 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 ,Y 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 filled in by the Building 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 ' &paved parking j # �f Parking spaces f rof Loading Docks a Fill: -(vol-ume -& location) 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. DATE: ����j�B �/� APPLICANT's SIGNATURE NOTE: Issuanoe of a zoning permit does not relieve a�411 pp nre burden to oomply %A tR4_all zoning requirements and obtain all required permits from the Board of Health. Conaervsation Commission. Department of Publio Works and other appiioable permit granting authorities. FILE # AUG 1 81997( s File No. i ZONING PERMIT APPLICATION (§10 . 2 PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: jj lArrl :) ) 0 P n A Address: , 1 X I LI ) LF—CU S j14 A Telephone: 2. Owner of Property:,A-Am_R _S 4 LCjL Y VDALL1~R Address: r-1 q D/Am p A S0 Telephone: 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain):_ 4. Job Location: t3q j/,02L&,o Parcel Id: Zoning Map# Parcel# ?' District(s): C_ .4 2 (TOD IN BY THE BUILDING DEPARTMENT) S. Existing Use of Structure/Property 9,S�.v��>4 1 6. Description of Proposed Use/Work/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 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 iY 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) w �V FILE I rj AUG 1 81997 APPLICANT/CONTACT PE ON: IUL, ADDRESS 19OtiE: PROPERTY LOCATION: MAPS PARCEL: THIS SECTION FOR.OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING F01RM EMLED OUT Fee Paid RidldinZ Permit Filled mit Type of Constniction- Addition to Existing <Z" v' ,v r T LLOWING 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 Per rom Conservatio om is '0 /2,0 Signature of Building for ate NOTE:issuance of at zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Department of Public Works and other applicable permit granting authorities. � z � w � co z OD a CD _ CD ILI En N �1 C A = b`b x• f� O ►�, C rY C (D Cu o Cbdr1 vv g- C Q � g rt °o -� = as �-y R 1� F" B ° ° R � � ca rn y � d La � �s, c �?crorj• �• ro � a � o < ° 5CD o < CD g4 F- ¢ o C) a r" M *1 8 \ 1 vii � C CD r•. � zrt � o 0 O aq C f.ry �t ll� v' � O 0 y c cL -in° g p o go C3 CD r CD rn O UO cn UG O �' Up C y � O Oy d O � .•1 ...� R' R Q' R' Q' a S R• v°a o• � �; � � b CD C� 3 � o Di n