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JOB No. 970C
03/ 1 -
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J PLAN �
SHEET No.
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. M Tel.No. Alterations
NORTHAMPTON, MASS. 'J F 19� Additions
'
' APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location ,rL�a1�t Y Lot No.
y 14 tk-cV/ ��� �.
2. Owner's name � � +� Address E1,
3. Builder's name d why? G t;tQ Address
Mass.Construction Supervisor's License N . ���` -7 / Expiration Date
4. Addition iC
5. Alteration 1 S't Floe,1 `� —�c✓0 1� -t'Lf1 -"\
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 1-- tZ,
13. Siding house Y
14. Estimated cost
The undersigned certifies t the above stateme is are we to the best of his, her
knowledge and li
Signature of responsible appicant
Remarks
��MPT
8199Y ox# ttn txn
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$ d �assacflnsetfs
DEPARTMENT OF BUILDNG INSPECTIONS
212 Main Street ' Municipal Building '
Gay SV,�•
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFE7AVTT
(license&l permittee)
with a principal place of business/residence at:
(Phone#)
(street/city/state/zip)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Daze)
0- 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) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach mkhtioml shed if neomuy to include information perft=ng to an ooatmdon)
(�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 whilo homeowners who employ persons to do mamma •, =stniction or mps it work on"Welling of
not more thaw throe twits is which the homeowner resides or oo the groin appurtenant thereto ace not generally ooasidered to bo
employers under tha wod='s compensation Act(GL152,ss 1(5)),application by a homeowm for a Beane or permit may evideaoe tho
legal datua of an employer underthe Wodcak compemation Act
I understand that a copy of this ttatemcut may be ferwuJad to the Depuftwes of buhutrid Aoeideorts•Office of Iaxuabos for the
covaage verification and that failure to soatre covaago under section 25A of MGL 152 can lead to tba imposition of criminal penalties
consisting of a fine of up to 51,500.00 andlor imprisonment of up to one year and civil peanitia in the form of a Stop Welt Order and a
fi m of 5100.00 a day against tno.
Signed this 7day . " l99' Fa Permit Number
�� NW Lot#
Sipab=of Licen ermitt x
10e 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_jL
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This —7— to be filled in
by the Building Deportment
I Required
Existing Proposed By Zoning
Lot size % ✓1
Frontage �,�G 45 C)
Setbacks Z ;? �� C'
- side L: '4 R: T7/ L: R: 77
- rear
Building height
Bldg Square footage -.I 3,S ?� �
%Open Space:
(Lotarea minus bldg
�J
&paved parking)
of Parking spaces
ht of Loading Docks
Fill:
(Vol-ume--& location)
13 . Certification: I hereby certify that the information c r2ned herein
is true and accurate to the best of my know-Ledge.
DATE: APPLICANT's SIGNATURE -
t NOTE: lAwaLinnoA of a zoning permit does not relieve an applioanYs burden to 0o pty' itt1 .all
zoning requirements and obtain all required permits from the Board of Health, Co� ewtstion
Commission, Department of Publio Worke and other appliomble permit granting authorit;es.
FILE #
J
MAY 8 199 1 hh
File No
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: S V Telephone: 'Y!,�?
2. Owner of Property:` I`' P9�`-�� ks V 4z 1/ �y
Address: r' �V Jj _ Telephone: ? o l
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): dFt-!q,-2 4C-�00
l a
4. Job Location: �—r' �/1-9 if
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE B ILDI G DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Pro ed Use/ l wt Rroject/Occupation: (Use additional sheets if necessary):
O® Cl-'{- FJ Y cY
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 L"� 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)
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f. FILE I 9 G J�tl1
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AWIC�/�CONTACT PERSON:
-" ADDRESS/PHONE:
PROPERTY LOCATION:
MAP c--7—'57A PARCEL: ��-
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Fee Paid
Building Permit j d
re _.
r,
f' ✓
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THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: k
Approved as presented/based on information presented ZC-1,;
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
P/ it from Conserva ' C --Q.61n
S S"
Signature of Building ector Date
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 Public Works and other applicable permit granting authoritles.
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