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25C-121 (3) QD z a M Z > -1 m r 0 O M Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 3 Alterations NORTHAMPTON, MASS. 1'2-1 f,� 19-V Additions % � ? APPLICa ATION FOR PERMIT TO ALTER Repair r/'// Garage 1. Location 6 / g �� / fir' Lot No. 2. Owner's name /G" LL �� ess 3. Builder's name G 114,t a Address Mass.Construction Supervisor's License No. Expiration Date t � 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 13. Siding house 14. Estimated cost- 5 The undersigned certifies that the above statements are we to the best of his, her knowledge and belief./ Signature of responsible app icant Remarks /de it /�G91" 1 6199 �-C1tAMP�, 9 dx ;CJ[ tTZ#�bi11t�1II1T 3 � 7[15 ACltnS[t14 DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 010 60 ' WORKER'S COMPENSAT.TON MS IUNCE A MAVIT (li t�nserJpermi tt ee) with a principal place of busine—s7s//reesidence at: D p �/ i�G1w // �� (phoney#) (� LS /eG (Slsz�t/city�p) do hereby certify, under the pains and penalties of perjury, that: O I am an employer providing the following worker's compensation coverage for my employees working on this job. (lasuranCe 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 Contractor) (Insurance Company/Policy Numbcr) (Expiration Date) (Name of Contractor) (Insurance Company/Poky Number) (Expiration Date) (Name of Contractor) (Ins r nc Comtiany/Pohcy Number) (Expiration Date) (Name of Contractor) (lasurance Company/Policy Number) (Expiration Date) (anach add?t oa-il date if ncccnxry to cnc} informer 0 perta u,n to all oo,,ndon) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:pica-se be aw2m that vblo bomcownm woo cazploy pc=ra w do mAiri, �couswdioo or rcpaq work on x dwclliag of not mocv than three units in wfrich the hotn6av r msida or on the vour>hs appartenaa thado atr not geacralty ooasidard to be cmploym under the wor a's compcav4oa Act(GL.152,=1(5))�applia6crn by a homcow=for a Uccnsc a permit may cvidascc tho It pl ctatva of an omployor under tbo Woricor'c Compcasatioa Act- I undastaad d-t a Dopy of thu c`Satcaxni ar,y bo fory i rd.od to tbo Departmca of IndzrsLial Atxidm&t oo of lu:uranoo for tba oovai.ge vaifieatioo and that failure to teatre oov`-;f o trndcs znetion 25A of MGL 152 can lead to tha impmifion of aimi1w penalties o0al sting of a fine of up to S 1,500.00 atxf/or of tip to one year and civil prnxt6a in the form of a Stop Work Order and a fim ofs100.00 a day against mc. Signed this f�4day of 1997 For&jMtnscotaluioDaly Pcrmit Number Map# Lot# igna �C= 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 (ocation: 11 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. This col=a to be filled in by the Banding 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) # Pf, -Parking Spaces f of Loading Docks Fill: (voJAime--& location) 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. DATIVE: : APPLICANT's SIGNATURE ✓ aL' v�ZG NOTE: issunnoe of a zoning permit does not relieve an wpplioAnra burden to oomply witty,+ali zoning requlrements and obtain all required permits from the Board of Health, Conservation .. Commission, Department of Publio Works and other applioable permit granting authorities::. FILE # 1 td File No._ AFC 61997 ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: 01 C�( C �t� 1`7 ST Y'/44 AEG - Telephone-. Address: 0 � C'S X//O/,7��'�''''' 2. Owner of Property: TO S °2 /Z Address: / r�� 2,q 6,CV 7 lU//D""l^' A,&, Telephone: _ 3. Status of Applicant: Owner X- Contract Purchaser Lessee Other (explain): 4. Job Location: Parcel Id: Zoning Map#� Parcel# I District(s): /I (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property 6. Description of Prgposed Use/Work/Project/Occup lion: (Use additional s ets 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,'Varia„ce/Finding ever been issued for/on the site? NO DON'T KNOW X YES IF YES,date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT 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 k 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 # DEC ! 6199 APPLIGAN� SJ TACT PERSON: f. PROPERTY LOCATION: J��n MAP `'C� PARCEL: / G ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM M.1 ET) OUT Fee Pflid Ryiilfjin2 Permit Filled nilt -Fee Pnifi New Constmirtion M i, 3 Set-, nf Plans I Plot Plan THELLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION. 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 fro Conserv_atio mmission Signature of Building lngKector Date NOTE:Issuanoe of a zoning permit does not relieve an applloant's burden to comply with all _ zoning requirements and obtain all required permits from the l3oard of Health, Conservation Commisslon, Department of Pubiio Works and other applioable permit granting authorities. t+� City of Northampton REQUIRED INSPECTIONS BUILDING DEPARTMENT I. Footings and Walls 2. Structural Components in Place* 3. Complete Building* No. 1184 Office of the Building Inspector Zoning Form No. 963108 Datel2/18/97 Fee$20.00 Check# 325 Page, 25C Parcel 121 ,Zone Section 127 ❑ Yes © No BUI]LDING PERNHI Ronald Mistarka * Plumbing and Electrical Inspections required THIS CERTIFIES THAT before Building Inspections has permission to repair porch roof, soffit & remove chimney Inspection on Site—Foundations situated on 15 Elizabeth St - Joseph Billieux 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 pen-nit.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 ** Install per Manufacturer's information: windows,vinyl siding,roofs Smoke Detectors(Fire Department) and woodstoves Other THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON THE REMISES "Certificate of Occupancy wilding Inspector