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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. L�G Alterations
NORTHAMPTON, MASS. / / 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
a
Garage
1.1. Location hA t-t� S c Lot No.
2. Owners name tom�. S Fe I( , /J} Address � j Al a o,, t,c 0r
3. Builder's name ✓Aih PJ n t J/I�✓,tr r Address ,/ � &A J Ja,
Mass.Construction Supervisor's Licen a No. d°d 1710 Expiration Date l ? 9
4. Addition !g s A
5. Alteration
6. New Porch
7. Is existing building to be demolished? PS
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating !n r h A U
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost l J J
The undersigned certifies that the above statements are we to the best of his, her
knowled a and belief.
Signature of responsible aAfllalll
Remarks d/frn O of k rG e, 6Y C. lnn r- P ',A
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B} °g GrZt� z121t�7II21
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JUN 2 11998
m DEPARTMENT OF BUILDWG INSPECTIONS
212 Main Street ' Municipal Building
_ Northampton, Mass. 01060 '
WORICER'S COMPENSATION INSURANCE + { AVIT
with a principal place of businesslresidence at:
(St-c--UM ty/stateJap)
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 wot�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 Con[ractor) (Insuranc Company/Policy Ntrmbcr) (Expirabon Date)
(Name of Contractor) (L sur-�ncc Company/Pokcy Number) (Expiration Date)
(Name of Connector) Gmsurancti Company/Pohcy Numbei) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attadr additional nc�ifnoccniry to inchidc informrtioo pertaining to ell oocrtrncton)
I and a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:plcasc be aw3=dirt wtxUc homcowom who cmploy pers to do ��coaslvctioa or rcpair work on a dNvclliag of
n,ot mexo than duce undi is wtnctl the homoowD,:r rt= cx«oo tbo grounder appuctcnant tbl-dl arc ooe gcucrally ooaxidacd to be
cmployaa undcr the w%kcr`s oompc=4ca Act(GL 152,=1(5))�application by a homcown<r for a ticcruc oc permd may cvidcncc the
lcgxl status of an employer under tbo wocicce. sLien Ac!_
I undaztand db x copy of this rat—'may bo forwarded to tbo Dcpnrtmcnt of Inbsstri'J Aoodmb 011]oo of Inwr�nco for tbn
covcrxgc vaificauoa and that fad me to scatrc covamgo undcr section 23A of MGL 152 can ksd to tbo'inzposdxo°of aunt penalties
ooaU1px8 4 a•fine'of up to S 1'500.00 and/or imprizoanx�of up to ooc yau-and Civil pcntl6 a in the form of"
Stop Work O[dcr and a
fim of 5100.00 a d>;y tPinA ar-
por l—coly
�* /' d/r('� PCimit Number
/ �fap�� _loti#
�<: Signature of Lio=scelPcrmittcc
JUN 210
CITY OF NORTHAMPTON
BUILDING PERMIT CHECKLIST
All 1&2 Family Proj eCtS The following items are to be
considered MINIMUM
information to be submitted with ALL permit applications
Address:
A Scaled drawings & details shall be submitted with each application proposing
construction, reconstruction, addition, alteration, or repair. The building officia
may waive the requirements for filing plans when work is of a minor nature.[V]
B. Scaled drawings & details shall indicate &describe all proposed work, including location,
size, grade of materials &equipment to be used. [.�]
C. PLOT PLAN, property address; map & lot number, zoning district & overlays (such as
wetlands) [ ] /VA
Show well and septic locations (if applicable) [AM
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. [�/J
Locations &dimensions of primary and accessory buildings & structures. [✓]
D. FLOOR PLANS, floor plan of each floor and intermediate levels including basements,
crawlspaces, terraces, pore es garages, carports, and decks, showing existing condition and
proposed construction. [
Dimensions, locations &mater is of foundations, footings, columns & piers {including
reinforcing when required) [,
Direction, dimensions, spacing &grade of all framing {floors roofs, walls, partitions) (�
Location of all walls, partitions, windows, stairs & doors [W
Location &description of all electrical equipment , alarm devices and smoke detectors [
Location&type of all heating and air conditioning (HVAC) equipment. km
HVAC schematics (where required check with building inspector) [aA
EXTERIOR ELEVATIONS Front, rear& side elevations including foundation and finish
grades. RX
Location &dimensions of windows &doors. V
Description of exterior cladding or siding mater
Show exterior stair locations &dimensions. [.
Show chimney and vent locations W4
DETAILS & SECTIONS, Sections through exterior walls showing details of construction
from footing to the highest point of the,building. C 1
Sections through fireplaces &chimneys (show clearances) Ww
Location &details of any roof trusses,glue-lam, or engineered lumber {include connection
details and Massachusetts professionals stamp on specification sheet) 191
Exterior envelope energy requirements : Uo-of walls,roof eiling&floors ..OR.. R value of
walls/roof/floor,also percent of window area to wall area. [Y
„m �;
5 -..
DEN OF SUIT
/Z/oy 6ea
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.
Thin column to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size q3-
Frontage / 00 I m o �3
Setbacks 0 0 v
- side L: (a R: SA_ L: G Z� R: 5:�
- rear
-36 :2
Building height 30 jU 3_i'
Bldg Square footage / 3 a p / l00 _�6
%Open Space:
(Lot area minus .bldg 7 ®Gl r
&paved parking) (O
# of -Parking Spaces
of Loading Docks
Fill: �J
-(volume -& location) /�pn t
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: G q APPLICANT'S SIGNATURE „ [ • /��� c is Ian
NOTE: havivaAca of a zoning permit does not relieve applioanYs burden to comply itFp ill
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission, Department of Public Works and other applloable permit granting nuthoritlea.
FILE #
JUN 21998
File No. �3 11 t
ZONING PERMIT APPLICATION (§10 . 2
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: I m P_S C. k"J ' j ra M S , �7f
Address: �� �q(� T(� °Telephone: 'C�
GJ'�l
2. Owner of Property: i 'J SDI ��,�ti tr_ r t'-1 G k
Address: 3,V /la-/C-J, 1,T t e__� Telephone:
3. Status of Applicant: Owner Contract Purchaser "Lessee
y Other(explain): /�. L-cr
4. Job Location: 41 5t
Parcel Id: Zoning Map# Parcel# District(s): f °"
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5, Existing Use of Structure/Property R1-S I r C n_r G
6. Description of Pr posed Usen
n rk/Proj c cupation: Use add""onal sheets if necessary):
/ r- h 14.1
7. Attached Plans: X 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_ 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 L1 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 # -963615--
ci
JUN 2 X998
APPLICANT/CONTACT PE ON: / ��� (� �-' 99
ADDRESS/PHONE:
PROPERTY LOCATION:
MAP „Z �� PARCEL: ZO
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMUT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FrI.I.ED OUT
Fee Pgid
]Rnildin2 Permit MUM ntit
Addition M Existing cc
Arressnry Structure
l C (/
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
Approved as presentedfbased 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
Sep tic Approval-Bd of Health Well Water Potability-Bd Health
,'--Permit from Conservation Commission J IN
Signature of Building Inspector Date
NOTE:tanuanae of a zoning permit does not relieve an applioant'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 applioable permit granting authorities.
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