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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.'?Y7 ~� Alterations
NORTHAMPTON, MASS. "c' 1-7 19 T
Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location y 6R6 56Y S.,P, Lot No.
2. Owners name T,lY/-./ 1�//"., Address V
3. Builder's name e C tz 'V Address
Mass.Construction Supervisor's License No. Oo 4-76 3 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 t� "`� a-✓•"�� �'.®��/� 5�, C��
13. Siding house
a�
14. Esdmated cosL- 3506
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
Signature of responsible app.icant
Remarks G
I?c1:66111- L,11
O�TY rp)0
} �� ? Crz �-f axtl ttitt f>?n .
B e Ma3fRChtrfClfig
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street e Municipal Building
Northampton, Mass. 01060
WOR.I=, Z`S COMPENSATION INSURANCE ' t AVTT
N�nse^Jpermi ttec)
with a principal place of business/residence at:
do hereby cer`ufy, under the pains and penalties of perjury, dlai:
O I am an employer providing the followutg worker's compensation cover2ge for my
employees worl:ing on this job:
-;7 16U6 9-JI X940,97
(Insurance Corapzny) (poLicy 1,,Iw bcr) (Expiration Date)
( ) I am a sole proprietor,65� cc or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) Qmsuranc-- Company/Poky Number) (Expirntion Date)
(Name of Contrzctor) (bnsuranc-- CompauyRo!icy Number) (Expiration Date)
(Name of Contractor) (Insurance Compa-M,/Policy Number) (Ex-pim6on Date)
(Name of Contractor) (Lasuranczz Company/Policy Number) (Expiration Date)
(cnarh additiocnl Fboct ifnoc<a to inclOck tnfar .,,pa c aiag w all ooa4 don)
( ) I am a sole proprietor and have no one worLing for me.
( ) I am a-home owner perfon1jima all the work myself.
NOTE_please be aware tla,t wkrilo bomcowocn wtio employ pa:om to do—immsnc a ma%trvction'or repair work on a dwelling of
rso(moct tb:a thtoo tents is which the bomoawocr rC=des or oa the Bounds sppurk nsrrt d.rn arc oo(gcacr,zlly 000sidcred to be
employ—under tbo wocicCC`s minim Ad(GL152,a 1(5)1 application by a bomcowncr for a liccwc cc pamd may evidence the
legal Flat",of an employee under dw Workceg Compoo3.11oa Act'
I uadcrstaad tali a oopy of tbi c etztrmca!Fray be forwarded to tbo Dcpert mccd of l-4w_i d A,,& !ofroo of Ia-•Auer for d.
03v=9c vu%csdoa and that failure to Faure eoversso=cadet soctioa 25A of MoL 152 cm lead to tbd impositioa of eriminsl pcaaltics '
ooasistiag of a Sme tf u�to S 1,500.00 anaor impraoamcai of up to one year and civil pmattics in the form of a Stop Work Otdcr and a
fine of S 100.00 a day lVd-1 tnG
Signed this l9 day of Sef'l 1997 Fordr�aalts,�oaly -
C� ma Number
Nmbcr Lot.9
Sigaa6rc of Li0=n$Ct/PCrIIlitt=
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 —I mm 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)
-pf "Parking Spaces
of Loading Docks
Fill:
(vol-lime--& location)
13 . Certification: I hereby certify that the information contained herein
G 1 is true and accurate to the best of my knowledge.
_
DATE: 1' ` y� � APPLICANT's SIGNATURE
f" NOTE: Issuanoa of a zoning permit does not relieve an applioanYs burden to comply wltla,,+pll
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
2 2
File No. V
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: N�'G � �` �� Telephone: t Y ef
2. Owner of Property: �✓�' 1 ��Y
Address: zJ Cic c1r S%` Telephone: 5
3. Status of Applicant: Owner il'*�- Contract Purchaser Lessee
Other(explain):
4. Job Location: 4/
Parcel Id: Zoning Map# 5Ia Parcel# yS District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property f /�`'``-:� ``se- & `C
6. Description of Proposed Use/Work/Project/Occupabon: (Use additional sheets if necessary):
/?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.
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 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)
f U
FILE #
PIL Al/ ONTACT PERSON:
ADDRESS/PHONE:
PROPERTY LOCATION: ', t 2�2
MAP PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM EITLED OUT
Fee PAid
Fee pnili �./
-20
Type of Cnmgtriyrtinn-
Addition tn Existing 1) 'cop
06'6_763
TEE>,OLLO WING 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 C t from DPW - Water Availability Sewer Availability
Septic Approval-Bd of Health Well Water Potability-Bd Health
Permit from Conservati oga
Signature of Building Inspector Dat
NOTE: Issuance of a 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 Publio Works and other applicable permit granting authorities.
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