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25C-095 (23) a T A V b o � � m -*� a 3 Z m .. v Z Zrn ::E A Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. d Alterations NORTHAMPTON, MASS. / 19 L7 Additions ' APPLICATION FOR PERMIT TO ALTER Repair Garage 1. Location Lot No. ? 2. Owner's name ^J Address // IGA&I)� S` A/�/��3 t�lC Address fiX/ c } /tJ 3. Builder's name 7 Mass.Construction Supervisor's License No..61'e�21) / Expiration Date //4!� 2' 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 /*a T�� L 13. Siding house /e P&Z4 14. Estimated cost:- I ' 6140 The undersigned certifies that the above statements are true to the best of his, her knowl ge and belief. Signature of responsible app,icant T Remarks c� Gel v�/I _ di'l i /�'-G�' �� ✓t //�� /�,� f/��J z22 zet-j •. Y- Plll CTit elf nz#�j&11tjJ IItt � 6 � �:sanchitsrtts r" DEPARTMENT OF BUILDING INSPECTIONS r" 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORI{ER'S COMPENSATION INSURANCE AFFIDAVIT (licensee/permittee) with a principal place of business/residence at: .��l�'��IU S�✓ ✓4�' �,�./�' .Jz"f1� dd��(phone#) Ste"��'�� (strcet/ci ty/statrlrip) do hereby certify, under the pains and penalties of penury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: (Insurance Company) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hued the contractors listed below who have the following worker's compensation policies: a (Name of Contractor) Gnsurance Company/PoLicy Number) (Expiration Date) (Name of Contractor) (Insurance CompanyiPoticy Number) (Expiration Date) i (Name of Contractor) (Insuranc: Comp;ul)vpolicy Numtxr) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional shed if mccczury to iocludc infwmitioo pertaining to all ocairadon) I I am a sole proprietor and have no one working for me. ( ) 7 am a home owner performing all the work•myself. NOTE:pl=sc be aware that while homcowncra wbo anploy perwm to do ma;r,fml ace wmtructioa or repair work:on a dwelling of not moon than three units in which the bomeawncr re=dca or oct the pnunc+sappurtenwA thacto arc not ecnvaky ooandcnod to be eaiploycrn under the w•oric i cocnpcasatitn Act(GL152�a 1(5))�application by a homeowner fora Gernx or Permit may cvidenoe the legal etatus of an on:ployor under the Workeet compomation Act I undcrrtand that a copy of this rt&tc ccd cnay bo forwa•dnd to the DcVwt_t of Inaautrid Aoadea&c'Moo o£Insurance For the cova-age vaification aad that fa-lure to scatre covernga under sccdoa 25A of MGL 152 can lead to tbo impozitioa of criminal peaatties ooasisting of a fine'of up to S 1,Soo.00 and/or inipriso=xnl of up to one)-car and dv pcnattia in the form of a Stop Work Order and a fins of S 10¢.00 a day igaiz A tae. Signed this 1 day of p U 1997 FCC dcpuft=3Wusoonly Permit Number Map# Lot# turc of Lioansc&Pcrruittee 10. Do any signs exist on the property? YES bZ NO IF YES,describe size,type and location:_ 1-9 LV, ,V i � f�'it/ �w�h `f' l✓o dj�/ d� 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 —lu= to be filled in 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 &paged parking) # pf Parking spaces #' of Loading Docks Fill: _(volume--& location) 13 . Certification: I hereby certify that the information contained herein G is true and accurate to the best of my knowledge. DATE: /d� %�� APPLICANT's Sl-GNATURE NOTE: leauanoe of a zoning permit does not relieve appliomnt's burden to comply Witty oil zoning requirements and obtain all required permits from the Board of Health. Ccnservotion Commission. Department of Publio Works and other applicabla permit granting authorities. FILE # File No. ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: /YY� /'&"�1/y Address: dpt'1'�:L/ 1ic)vtl3 )tf4r✓�'��TeIephone: 5FC •- ?. (J F 2. Owner of Property:) , ^ 7 Address: _.7 J�/l/o&))- Ajo"-j Telephone: 3. Status of Applicant: Owner _Izcontract Purchaser Lessee Other(explain): 4. Job Location: �/ /j/C�J�- �� ✓— o�/C/1 U��i� //_ /�/1 T Parcel Id: Zoning Map# Parcel# District(s): (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5, Existing Use of Structure/Property 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): 'f �� U��✓ t .Al✓� A.).-06P. L2 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. S. Has a Special PermitNariance/Finding ever bb 'slued for/on the site? NO DON'T KNOW— y 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�ON'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 # 962889 OCT 1 41997 APPLICANT/CONTACT PERSON: JX4 �].DRESS/PHONE: PROPERTY LOCATION: MAP c �`C� PARCEL: VIJE J ZONE Ali` THIS SECTION FOR-OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCL SED REQUIRED DATE ZONING FORM FULED OUT Fee PAid Building Permit Fille-d pjit Type of Cnmqtnictinn- Remodeling Interior AtifEtion to Existing 0�iner/Orriiwnt ,Stnt -7 (� — ✓ THE FOLLOWING ACTION HAS/BEEN TAKEN ON THIS AP ICATION: Approved as presented/based on ' formation presented Denied as presented: Special Permit and/or 'te 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 Commission Signature of Building Inspector Date NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain ail required permits from the Board of Health, Conservation Commisslon, Department of Public Works and other applicable permit granting authoritlos. FILE # r Wr f PL1 N7 T/C'ONTACT PERSON: �� rZC�7�Z % fed ADDRESSIPHONE: PROPERTY LOCATION: - 0 N MAP PARCEL: !t5 ZONE THIS SECTION FOR.-OFFICIAL USE ONLY: PERNIIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FOR EHLED 0111 Fee PAid Type of Constniction- Arressnry Structure �-- 3 Cetc of Plane /Pint Plan — THE ,OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION- 1-1 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 Conservat' Commiss' n 011-9/54V 1 Signature of Building Y4ector Date NOTE: Issuanoe of a zoning permit does not relieve an applioant's burden to aempty with all zoning requirements and obtain ail required permits from the Board of Health, Conservation Commission, Department of Publio Works and other applioable permit granting authorities. A�° -may City of Northampton REQUIRED INSPECTIONS 1. Footings and Walls BUILDING DEPARTMENT 2. Structural Components in Place* 3. Complete Building* No. 986 Office of the Building Inspector Zoning Form No. 962889 Date 10/17/97 Fee $40.00 Check# 1916 Page, 25C Parcel 95 ,Zone URB Section 127 ❑ Yes ® No BUI]LDINGPERMI r I-I *Plumbing and Electrical Inspections required THIS CERTIFIES THAT Jim Dawson before Building Inspections has permission to demolish storage building (no utilities) Inspection on Site—Foundations situated on_211 North St - Bob Raymond Inspection of Plumbing—Rough provided that the person accepting this pen-nit 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 P MISES ,. Certificate of Occupancy Building Inspector