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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.NQ. .} / J Alterations
NORTHAMPTON, MASS. c� °' lg Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location u aa Lot No.
2. Owner's name 0. . e Address
3. Builder's name Gf. Address 17 6,1- �-7"
Mass.Construction Supervisor's License No. Q/0 `7 1 T1 Expiration Date //' ° �— 9 7
4. Addition
5. Alteration pc� k
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
13. Siding house
14. Estimated cost-All
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
1
Signature of responsible app icant
Remarks
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Arssachn'scltc
m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORZCER'S COMPENSA'T'ION INSURANCE AX, , AVIT
(11�dscc/peruu ltc:
with a principal plaoc of busnesslresidence at:
Z/ 1 "4,F-J (Ph one ),9% 7—,5—?0
(strr�L/c�1}'�sl2lt�Z]p)
do hereby cer-tif),, under the pa-ins and peaalLes of perjury, that
( ) I am an employer providing the following Nvor,r_er's compensation cove:-age for my
employees worming on this)&
(LIlsZ=CE Coap2ay) (Pohc7 Number) (E_xpira6oa Dale)
( ) I am a sole proprietor, general coornctor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Namc of Contractor) �o..surancz Compauy/Pobq Number) (Expura6on Datc)
(Name of Contractor) (1LSutaccz Cotnp:-ty/Policy Number) (Lxp ratio❑Date)
(N2tne of Contractor) (Lnsura--� Corsrp?-ay/poucy Nu1ab�:-r) (F---)�"piradoD Datc)
(Name of Contractor) (Ln-siivanc. Company/Poky dumber) (Expirziio❑Date)
(rllicll a.dditioal ra-et ifnc�'r�iry t.o o.-.Ud�iafoanaeo pc�:.^sn�to.11 a�rLOn)
pQ I am a sole proprietor and have no one worL-ing for me.
( ) I am a home owner performing all the work myself.
NOTE-plcasm be swum the vibDo bomcowocra wbo cloy pasom w do +�c0¢zrructioa'or rmp worst on a d-,U ng of
ant moan thin ihmo units in wbich tlx bcmooivocr r .do a as tb,Upuncts zpV!rL-.1d tbx o um got Scxrvlly coosirScrcd to be
cmploym uodcr tbo veockcr`:minim Ac1(G L15Zn t(S)} applic�0oo by a bomcowttr fora liccwc cc perntl may cvidcacc tllc
Ic-pl etatxu o£an cnployoe uoderdh Wockcet Coosponaatioa,kcL
[underztand[hzi�Dopy of thu eats vcat may bo f«-v.nrded to tbo Depar4neot aClndutri el,toc;deaa'OfSoo of la.�uwou for tbo
covcragc vctific3lioo and th t fa u c to ccatrm cowrnbo under soctioa 23A of MOL 132 c:n Lmd to tbo lmporitica ofcrimi pca 1bcs
oomisting o£a fine bCup to S 1 500.00 md/or imprao®mt of up to one year and aril per-16c3 in the f«m of a Stop Work Ordcr sad a
ffno oCS 100.00 i day agp.iwt mc.
Signed this day of 1997 Foy&P�->, -ty
Permit Number
Si&aattxm of Liccnscc1Pcrmi0cc
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 —.Iu= to be filled is
by the Building 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 parking)
# f -Parking spaces
f fof Loading Docks
Fill:
4vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
D71TE: P 1- 5— 7 APPLICANT's SIGNATURE
_2_0
`:..
NOTE: laauanoe of a zoning permit does not relieve an applioant's burden to oompty wltfi,.Apli
zoning requirements and obtain all required permits from the Board of Health, Conaervtation
Commission, Department of Publio Works and other appliomble permit granting authorities.
FILE #
� I
AUG 2 2 1997
`=_ ! Fi1e No. i
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: 17.1 IJJ- P ' � elephone: "7 --
2. Owner of Property:�lc�_a���- 1 rje�r�
Address:-.) Ail)e- Telephone:
3. Status of Applicant: Owner 'x Contract Purchaser Lessee
` Other(explain):
4. Job Location: r C, � // Q
Parcel Id: Zoning Map# ( Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property G2 Sri
6. Description of Proposed UseAlVork/Project/Occupation: (Use additional sheets if necessary):
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_Y-- 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 # C) _) 92
APPLICANT/CONTACT PERSO : 44�-W ZVA e- Q.
ADDRESS/PHONE: /'y/ 3
PROPERTY LOCATION: C �
MAP cPS'C- PARCEL: 7' ZONE aj-g--
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM EHLED OUT v 3
Fee Pnid
Riii1ding Permit Filled nut
y
c Qs-
T OLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATIOM
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 Conservation Commis 'o
Signature of Bui ding Inspector Date
NOTE:lssuanoe of a zoning permit does not relieve an applioant's burden to oomply with ail
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applicable permit granting authorities.
go City of Northampton REQUID INSPECTIONS 1. Footings and Walls
BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
No. 1083 Office of the Building Inspector
Zoning Form No. 962692 Date 11/14/97Fee $40.00 Check# 1065
Page, 25C parcel 72 ,Zone URB Section 127 ❑ Yes ® No
BUI]LDINGPERMIT
*Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Gerald Archambault before Building Inspections
has permission to remodel kitchen & bath Inspection on Site—Foundations
situated on 29 Day Ave - Janet Carrier 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.
Building Inspection—Finish
Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON REMISES
Certificate of Occupancy
�,�uilcling Inspector