25A-107 (25) a
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
aNORTHAMPTON, MASS. Airq g- Ici 7 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
pp Garage
1. Location 355 13 r q e S t Lot No.
2. Owner's name 'ReJ4.f Ta I.,2-,; C4.,: , �s o.l Address 3Ss" R=jo 1 f-
3. Builder's name Cj- fe 14.,,,. =npcove,nea Address 3-1 P..,c -S A.», bec,t
Mass.Construction Supervisor's License No. 0r0002-6 Expiration Date 9-2.& 'a6
4. Addition
5. Alteration
6. New Porch nresyyrc I r«Joi pa.-c 4 -e r Cj";'t
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 tt }j f
13. Siding house V A44 S G,AS AA J rc,0��ce,�+t�I w,1 7t,.is � �wv ��,�•)
14. Estimated cost-
UGC.
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible app pant
Remarks
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' AUG 71997
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
w0MCER,S CoN2ENSATION INSURANCE All=AVIT
6-74_
(li�n_s�/peruiittr:)
v✓ith a principal place of businesslresideoce at:
_ ;311 Rae A^ �e.s/ l41/4 (phone;") 5--✓ef- S"Ys- !
(s a r°t/c ty/stn LcJzi
P)
do ' ereby certify, under the pains and peaaldes of perjury, Lhai:
O I am as employer providing the following \vor' cr's compensation coverage for ml'
employees woridDg on this)ob:
(Insurance Compzny) (Policy Number) (E piration Date)
Alam. a sole propric*, eneral contractor or homeowner (circle one) and have hired
the oc— tractors listed below who have the following worker's compensation policies:
(Name of Contractor) Company/Policy Number) (Expiration Date)
(Flame of Contractor) (Insurance aarpa>7yl?obcy Number) (Expiration Date)
(Name of Contra(nor) Qnsuranc-- Compauy/Pobcy Numbu) (F.x,-pLm6o❑ Dale)
(Name of Contractor) (Ina=c-- Company/Policy Number) (Expiration Date)
(emit a.d&tioo�d d—:a irnocc=ury to MCR16c mfomm oa pcsnimug to all ma:'-on)
( ) I am a sole proprietor and have no one wor-Ling for me.
( ) X am a--home owner performing all the work myself.
NOTE-please be aware the ti bi]o bomoowncn wbo employ pazons w do coasniajoa-or repa-ir work cn a d.+clling of
not mocc th_n thaoo units is wtnch the bocnoowocr rcaido or oa the Bounds appurtcnsrri tbacto ere oo(gcocv.tly considered to tic
c aploy—under tbo tvockct`s ocmpcns ca Act(G L152-s 1(5)�applimdoa by a bomcowmr far a fio=c cc perma may evidence t>x
is i rtahu of an cncployee undertho Workc et Compamalioa Act'
1 undcrsts ad that a copy of this cabmend may bo forwnrdad to the Deparmr of of Indutri d Aoeidmra'Of 0o of Iavca000 foe d-
eova q,e vai6cidoo and that fWurc to cocum covcmv undo socdoa 25A dMOL 152 esn lced to tbd imposidoo of criminsl pcaaltics "
norms cng of a j5ne bf uQ to S I,5oobo androc impr 600mm[of up t.o ooc year and civil pmariics in the form of a Stop Work Order and a
find 0(:S 100.00 a day againA tae.
Signed this O?_day of 6jiaJ 1997 Fo<d to--'1y
/ Permit Number
/f eft� 2vfa¢! Lot#
Signature of LiocnscrfPc>;miticc
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 colmn to be filled in
by the Bni.ldiny Department
I Required
Existing Proposed By Zoning
Lot size 2 le, a
Frontage -78` l
Setbacks - �
- side L• `I' R: I2 L:_ R:
- rear
02
Building height X 8 '
Bldg Square footage
5�•�e .54,x,
%Open Space:
(Lot area minus bldg
' &paved parking)
# , f Parking Spaces
f rof Loading Docks
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: Aug, c'7 q-7 APPLICANT's SIGNATURE
NOTE: IssuaA040 of at zoning permit does not relieve an applioant's burden to oomply wlW,all
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 #
AUG 7 199(
File No. 1 y
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: Caa f,t (1�•n0- r,Oro�e men
Address: ai ti p,.,,e V A—liet J _ Telephone: gi3-,i y1 S'15^1
2. Ownerof Property: t .�� >!4r us�� a��zr' C ,��v Tros
Address: 36S . r � Telephone:
3. Status of Applicant: Owner t1 Contract Purchaser Lessee
Other(explain):
4. Job Location: S
Parcel Id: Zoning Map# Parcel# 6 r7 District(s): '
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/O ccupation: (Use additional sheets if ecessary):
S, �C h Viet'd SiJi:1y 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)
21G36
FILE 96
# N'f
APPLICANT/CONTACT PERSO
ADDRESS/PHONE: vell —,A
PROPERTY LOCATION: 5 � / L
MAP . PARCEL: D'7 ' Z NE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM IMLED OUT
IRTiilding Permit Filled mit
Fee pflid
Type of Constniction-
Rernndelin2 Interior l ✓
�?
4-t.,e A _
Addition to Exkting z����Ax
THE LLOWTNG 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
Permit from Consery on Commission i o
.,te;f-W� - �/,-Z.
Signature i ector Date
NOTE:luauanoe of a zoning permit does not relieve an applioant's burden to oomply with all
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission, bepartment of Publio Works and other applioable permit granting authorities.
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