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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Te .No. Alterations
NORTHAMPTON, MASS. 1 q�7 Additions
: Repair
' APPLICATION FOR PERMIT TO ALTER
Garage
1. Location 5 SN. Lot Non.
2. Owner's name L v Address wct S'4G 1 Vo�7�ip�+�l�fi6't Yn,
3. Builder's name ear ' rac► ' Address G 3 (5i.5-7 S 7` C`~�. s Tha•--„ro TaH
Mass.Construction Supervisor's License No. O 3 116' Expiration N Expiration Date j !li!iz
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 5 r r�.n.l r o 0 Pa r e 12
13. Siding house
14. Estimated cost
tt The undersigned certifies that the above statements are we to the best of his, her
knowledam and belief.
Signature of responsible app,icant
Remarks
11IJf p�.
�oy �Z;� Df �17Z�IJ�21ir�JfII71 .
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A DEPARTMENT OP BUILDDZC INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S CO TENSAX'ION INSURANCE AXI I AVU'
c� l�a- I`a —_
-.nth a principal place oFbus*nesslresidence at: 1
do hereby cer-iFy, u-ndcr �he pins and p(,aades of perjilry, ill?i.
( ) I i-�m ao employer providing the followui )g v.or'',&s compensation coverage for nw
employees Woridng on this job:
(L si-L=ce Cody) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general coocactor or homeowner (circle one) and have hired
the contractors listed below who Have the foilovII'Dg worker's compensation policies:
(Name of Contractor) QInsuranc-- Corupa ,/Pok—f Number} (Expiration Date)
(Namc of Contractor) DaIc)
(N2-me of Coatzac{or) (tnsur nr Comy2-ay/Policf WEE-,J) (Ex-pinoon Daic)
('Namc of Contractor) (instzranc-- Compioy/Pohcf Numb-s) (Expir,uon Dam)
(c.n�.c3 w`di�omt rbod ifococa..ry to c:..'�dc iafortzia�ca PC^._img to.11 oc�r-won)
(l am a sole proprietor and have no one work-io8 for Mc.
( ) I am a-home owner performing all the-woF',, Myself.
NOTE_please be Amrt th:t vihi]o bocrrn�v_ ,t,ca,loy pcY ,to So .; �,a�r-C oc�.,r 6c 'O ct rcpzirworkon C..cllin�or
Got morn tb_n t1Yroo units is Wtnch th-6cc,:o:vncr rcido cr oo the P-Q x Tpuul -'ct ttxrcto uc ocC gcri[Iy coc;dcr-j to be
employers under Lbo t�SCes4,�pe:x::lim lid(G l_I52,rs 1(S)�nppliation by�6omcowncr far a lictnx a permit may evte'.:�the
Icg�!cl=nia of sa e;nployx under rho Woriccla Compow•tion.\t
I undcrrixnd[hid a Dopy oI lhi.�+.� -c;i c„y fN f«wvd«!to cbo A•po.�o3t of Lo�'ui�-ic7��adcaL'OiGon of I-vr�ow for t�
coycixsc vcrificiiion and tb_t r+durc to rcc Lu uadcr scctioa 23A of MOL 152 ran tcut to tbo'impos tier,of crlmi zxl pct cs
oomistisg of;.-Fme bCup to S1,500.00 mG/or improoameat orup to woe ycr,nd aV2 Pcmltio is the Corm of A Slop Wors Order and
fiWO(Si00.00 141y LviuA.asc
S i gn cd o 1997 For a.Pum>�,I�nary
Permit Numbcr
Map�S Lot d
Sigma of L'i ctmiticc
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 colt to be filled is
by the Bnildiag Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&Paved Parkingli
# of Parking Spaces
f rof Loading Docks
Fill:
4vol-time-& location)
13 . Certification: I hereby certify that the information contain erein
is true an accurate to the best of my knowl e.
DATE: APPLICANT's SIGNATURE
NOTE: Issuan of a zoning permit does not relieve an applioant's burden to comply wit4,, all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
FILE #
File No
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: IALfrefi-
Address: `- a57- 5 7— Ea.,?�,.r 6* &Telephone: C "C_--S-p. 2- 7
2. Owner of Property: /TI c /c," L
Address: 5� a! ��. 1ephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: c e wa"'4 S r
Parcel Id: Zoning Map# 1B Parcel# / District(s):GG
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
S. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
SJ,e
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)
FILE # .,
:r ' 81997
APPLICANT/CONTACT PERSON:
ADDRESS/PHONE: - rJ
PROPERTY LOCATION:
MAP _ I PARCEL:
THIS SECTION FOR-OFFICIAL USE ONLY:
PERNHT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
c — ✓'
T EKLLOWING 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 9,Ut,�om DPW Water Availability Sewer Availability
Septic Approval-Bd of Health Well Water Potability-Bd Health
_P ' fro once va ' Co n
Signature of Building ector Da Lt;
NOTE: lssuanoa of a zoning permit does not relieve an applioant's burden to oompty with all
zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
o TI
City of Northampton REQUIRED INSPECONS 1. Footings and Walls
BUILDINGDEPARTMENT 2. Structural Components in Place*
3. Complete Building*
No. 895 Office of the Building Inspector
Zoning Form No. 962795 Date 9/22/97 Fee $20.00 Check# 1793
Page, 31B Parcel 121 Zone URC Section 127 ❑ Yes ❑ No
BUI]LDING PERNUT
*
THIS CERTIFIES THAT Western Mass Siding & Roofing Plumbing and Electrical Inspections required before Building Inspections
has permission to strip & shingle porch roof Inspection on Site—Foundations
situated on 5 Edwards Square - Helen Lucy Inspection of Plumbing—Rough
provided that the person accepting this permit shall in every respect Inspection of Plumbing—Finish
conform to the terms of the application on file in this office, and to the Gas Inspection
provisions of the Statutes and the Ordinances relating to the Construction, Inspection of Wiring—Rough
Maintenance and Inspection of Buildings in the City of Northampton. —
Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring—Finish
of this permit.Expires six months from date of issuance,if not started. Building Inspection—Rough
Note:A certificate of occupancy will be issued by this office upon return Insulation Inspection
of this card signed by the Plumbing,Wiring and Building Inspectors.
** Install per Manufacturer's information: windows,vinyl siding, roofs Building Inspection—Finish
and woodstoves Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS P C N T ISES
Certificate of Occupancy
` t- Building Inspector