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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. (o—-15-7-5 Alterations
tk r-NORTHAMPTON, MASS. 19 E Additions '
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location P bc,A ��o Z£.N C t MA Lot No.
2. Owner's name AN i l— P. C Ay A N At)u N Address Vo 3 N\Ap't..f, Q kAQ e ��L,-I i=N C c
3. Builder's name Address
Mass.Construction Supervisor's License No. CS 0'5 \?-5!5 Expiration Date a 1 5
4. Addition �Ao o�S� a �o i.a �;.�.�.� i 1,Q R o ok VA SG Ft w.NhW SEAT
5' tl 0,
5. Alteration rrns•v�l .X✓✓•-��c �"c3 1�vv-�•-e P�Ca't1l-.-y
6. New Porch A )
7. Is existing building to be demolished? i�U
8. Repair after the fire C)
9. Garage / No.of cars \ Size
10. Method of heating �iCiR C C 1., o i M�i R ( �x�-S T1 f4!1 )
11. Distance to lot lines
12. Type of roof 4/l(b 1-� PRvPo`�tla P00 %%tON
13. Sidinghouse % J-(o CCOMI, CL. gyp CA(I0S
14. Estimated cost:-
3�a n
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
CcJ
Signature of responsible 14picani
Remarks 7�emu s '7 D
CITY OF NORTHAMPTON
BUILDING PERMIT CHECKLIST
All 1&2 Family Proj eCtS The following items are to be
considered MI IMUM
information to be submitted with ALL permit applications
A Scaled drawings & details shall be submitted with each application proposing
construction, reconstruction, addition, alteration, or repair. The building official
may waive the requirements for filing plans when work is of a minor nature.[
B. Scaled drawings & details shall indicate&describ all proposed work, including location,
size, grade of materials &equipment to be used. fi
C. PLOT PLA , property address; map & lot number, zoning district & overlays (such as
wetlands) [
Show well and septic locations (if applicable) [ ]
Location of lot lines, dimensions of lot, frontage ['
Location&dimensions of public easements,public utility easements, railroad right of ways
, and established zoning setback requirements. [ ]
Locations &dimensions of primary and accessory buildings & structures. [ ]
D. FLOOR PLANS, floor pl of each floor and intermediate levels including basements,
crawlspaces, terraces, porciels garages, carports, and decks, showing existing condition and
proposed construction. [41
Dimensions, locations &mat ials of foundations, footings, columns &piers {including
reinforcing when required) [ �]
Direction, dimensions, spacing&grade of all framing {floor roofs, walls, partitions) [
Location of all walls, partitions, windows, stairs &doors [
Location&description of all electrical equipment and alarm devices [ ]
Location&type of all heating and air conditioning(HVAC) equipment. [ ]
HVAC schematics (where required check with building inspector) [ ]
EXTERIOR ELEVATIONS, Front, rear &side elevations including foundation and finish
grades.[ 'i
Location &dimensions of windows &doors. [ /�
Description of exterior cladding or siding material. [
Show exterior stair locations &dimensions. [ ]
Show chimney and vent locations [ ]
DETAILS & SECTIONS. Sections through exteri walls showing details of construction
from footing to the highest point of the building. [`
Sections through fireplaces &chimneys(show clearances) [ ]
Location&details of any roof trusses,glue-lam, or engineered lumber {in de connection
details and Massachusetts professionals stamp on specificati sheet} [
Exterior envelope energy requirements :Uo-of walls, roof ding&floors..OR.. R value of
walls/roof/floor,also percent of window area to wall area.
0 4-CttAMp
s� MAR 1 2 i998 Crx laf1xzttntart _
B B
�lasaxcf{nsctta � I
m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE Al MAVIT
Clicensedpermi��ee}
with a principal place of bu.iness/residence at-.
(phone#)
(street/ci ty/state/a p)
do hereby certify, under the pains and penalties of pemiry, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working o this job:
(Insurance Company) (Policy Number) (Expiration Daze)
( ) 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) (lnsi=ce Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy/Pohc y Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiraton Date)
(Name of Contractor) (Insurance Company/Policy Number) (E)piration Date)
(attach additlocal:beet ifnoccauy to inehide informatioa pertaining to all ooatmci )
( ) 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 that while homcowncra who employ parom to do maintcaancy comtr,r oa.or repair work on a dwelling of
not am m than throo units is winch the boqxowncr resides or oa the grvj0ds appurtenant thereto are not generally oomidered to be
employtsa under the wazkce%compcns4ca Act(GL152,ss 1(5)�application by a homeowner fora licensa or permit maY cvidcace the
legal etahro of an employee under tho W ockeet Compematioa Act
I understand that a oopy of thin cia cmmL may be forwarded to tba Depwtmeo2 of Io&LA ial Ac6dea&O&oo of Imauaoco for the
coverage verification and that failure to sea=covcrago under section 25A of MOL 152 can lead to the imposition of criminal penalties 1.
oomistiug of a fine of up to S 1,500.00 and/or imprisonment of up to one year and civil peaslties in the form of a Step Work Order and a
firm of X100.00 a day against mc.
q For dq=tmMW use only
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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 cola= to be filled in
by the Building Departr t
Required
Existing Proposed By Zoning
Lot size I
Frontage
Setbacks - frnnt
- side 1-:_*)'
: *)' R: q 0 L:-" R:
- rear d /
4Y
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg � rC���,
&pared parkingi
# of -Parking Spaces
# '8f 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: / /J l l y APPLICANT's SIGNATURE ��
NOTE: Issuanoe of a zoning permit does not relieve an applioant's burden to oomp wttfa all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applionble permit granting authorities.
FILE #
' L MAR 2 IM }
File No. 965-,-3
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: D BN I E L P. rAV 8(V 19 U G H
Address:Jli2 MA1216 R XlQe, ti21 F�unfior"C Telephone: Yf 3 -- 59(o " -757 5
1 Owner of Property: (��t�t� 4- �. C'�1Vt�'►t�f i915C�1-}
Address: SA(or, m AiMJ C Telephone: '5, 86 --7,5'7!5
3. Status of Applicant: _.Owner Contract Purchaser Lessee
Other(explain):
4. .lob Location: � b � mfip1z C 16CAE fZlJ(AL)
Parcel Id: Zoning Map# Parcel# : - 1 _ District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5, Existing Use of Structure/Property &P—s t N TAB —
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
� '1 �l C� C', k Li.` I `i X11 ,> a � �` z' < uia v c l
J < j c '
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.
S. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO X 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 # 3
jL 101 2 !
APPLICANT/C NT?ACT PERSON �LP P �, Lell
r rr ADI37MFMH + E:1
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PROPERTY LOCATION: 7�
MAP PARCEL: 07(,/ ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
T
Fee Paid
RuildinZ Permit Filled nut
Fee Paid
New Cnn--,tr1irtinn
Remnfielin2 Interior
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Arlriitinn to Existing
Accessory qtmirfitre
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
Approved as presented/based on information presented e-
arsp�,jC
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
`� rCfl .of Health Well Water Potability-Bd Health
Permit from Conservation mission g
Signature of Building or Date
NOTE:luauanoa of a zoning permit does not relieve an applioanYs burden to oompty with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commlasion, Department of Publio Works and other applionble permit granting authorities.
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