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25C-136 (5) 'L7 ° C^ �; R_ i O o cn O 'Z E5 Z Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel No Alterations NORTHAMPTON, MASS. L1 `<' 19 Additions 91 APPLICATION FOR PERMIT TO ALTER Repair -; 1 Garage 1. Location Lot No. 2. Owners name�p f, ? d' f' cl�, ' Address 5 C, 3. Builder's name is 1 � , : ��_r �. Q Fr„�,�.,Address :'� %•� c T7„�,� ;�t"z ., I�� Mass.Construction Supervisor's License No. 0 ",4 4 /f- ci Expiration Date 4. Addition 5. Alteration 6. New Porch 7. Is existing building to be demolished? S. 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- " The undersigned certifies that the above statements are we to the best of his, her knowledge an Signature of responsible app icant Remarks fi0Rt it/J(p T0 ls�o B 6 �zssnchrtsclls DEPART1r(ENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORRER'S CONMENSA`)'ION INSURA-NCE A , t AVTII (h alp roil(u;) vrith a principal place of business/residence at: `7j (� � <V ,. 7 h'/g21CJZ3 p) V do hereby certify, under �he pens and peLialdes of perjury, than. ( ) 12ID an employer providing the lollo`.ving %vor'l,crs cornpensarion cove age for my employees working on this job. (Insu cc Cony) (P0L CY 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 Conn-acwr) �n c-- CompaM,[Pol cy Number) (Rxp mtioa Date) (Name of Contractor) (InsUr-.ncti Company/Policy Number) (Ex-pimcioa Date) (?`lame of Contractor) (Lnsurdnc° Comp2m,/Pol1cy Narr-h,--r) (Lip radon D21c) (Name of Contractor) -- (InstLauuc Comp uy/Policy N unb°r) ( Ypiratioo Da-LO (c1Y�at'ditioml c?�.-,c1 it ncccisry 20 oc.`ixk�a.�crmij co Fc::ur_iub to all ccri-r_Gor�) am a sole proprietor and have no one worEng for me. ( ) I am a-home owner perfor7uing all the viork myself. NOT please be aware th)t vihi]o bcc o,D v,bo employ pers to do ;.,�coca ructioa or r�work on•cf—aing CC not--,:th_u thrw units is w-tnch the w the Vvj-. s ippuctma tbcrdv arc not&cocrctly ooa idand to be cmplaym undo tbo"wciccx z o=pamiLlIca/pct(GL152--:1(5) appdca600 try&bomcowncr Car a li«nx oc permid=y Mac LbC legal rtabi of as employae undrrtho WorkCet Compcm,-.tioa A.ck_ ' I undcrzi_and 0—t a oopy of tbi+cat<mmt m.ay bo f«wnrd>d tv cbo Dqaranmi ollnd rz7i cl.loc 6—&Of —o(L.c, .noa for 01. covers;;e verification and that aAurc to taurc covcrabv uadct soctiea 23A 01 MOL 152 can kz.d to tba'imposition of crimi34 P-16- ng or&-fine bf up to 11-500.60)d/CC,mprvo¢mcat CCup to ooc ycr and C;Q pm 2t Cl is the focm oC a Stop Work order and a fine 0(-S 1 00.00 i day L&Linsx tnc Signed thi- —dav Of , ✓ �j _ 1997 For dcp crh=cr ty 1 Permit Number Mapi Lot 9 Si �titrc of LiocnscrJPcrmiu- 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 colt 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 ' &paned parking) of "Parking Spaces f %f Loading Docks Fill: 'Avol-ume--& location) 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my know a e. DATE: �zonlng APPLICANT'S SIGNATURE NOTE: Issuanoa of permit does not relieve an applioanYs burden to oompltr wit4,,4111 zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Department of Pubtio Works and other applicable permit granting authorities. FILE # AUG 1 8199-1 File No. ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR P=T ALL INFORMATION 1. Name of Applicant: / �`�`�'f c r �. `> _ ��. ,mss,.,.. ,� Address: ?5 r,Telephone: 2. Owner of Property: Address: Telephone: �` 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): 4. Job Location: Parcel Id: Zoning Ma p# C Parcel# District(s): (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property b/-,,5 E 6. Description of Proposed Use/Work/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 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) t FILE # U G AUG 1 81991 APPLICANT/CO�TACT PERSON- I7I ,a�f ?l � / � d J 7 ADDRESS/PHbNIE: ` 1 PROPERTY LOCATION: �- - MAP .�L PARCEL: --ZI ZONE THIS SECTION FOR-OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM M,T.FD 01IT Fei, Paid Rifflding Permit Filled mit Fee Pnid lRerandelin2 Tnt rior Al, e-4,0C Addition to Fyiqting THE LOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION: < 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 Conservati o n Signature of Building hiWKtor 15ate NOTE:Issuance of as zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits from the Board of Health. Conservation a Commission, Department of Public Works and other applicable permit granting authorltles. tUW a o� �~e Cit y of Northampton REQUIRED INSPECTIONS } ' BUILDNG DEPARTMENT 1. Footings and Walls * 2. Structural Components in Place 3. Complete Building* No. 781 Office of the Building Inspector Zoning Form No. 962664 Date 8/20/97 Fee 2$ 0.00 Check# 1737 Page, 25C parcel 136 Zone URB Section 127 ❑ Yes ® No BUI]LDING PERTVHT * Plumbing and Electrical Inspections required THIS CERTIFIES THAT western Mass Siding & Roofing before Building Inspections has permission to install replacement windows Inspection on Site—Foundations situated on 58 Elizabeth St - John Graiff 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 pemlit.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 CONSPICU�L MISES Certificate of Occupancy Building Inspector �� ?�f;�, 3 c�� U �� 1 ._.....�.._..._. i. �' -1}� ,I e l I �� 1 S � w �. i t I _r _ � City of Northampton REQUIRED INSPECTIONS * a BURMING DEP r 1. Footings and Walls ARTMEN r 2. Structural Components in Place* 3. Complete Buildh-ig* No. 781 Office of the Building Inspector Zoning Form No. 962664 Date 8/20/97 Fee $20.00 Check#p 1737 Page, 25C parcel 136 Zone URB Sec:ion 127 ❑ Yes No B U11'L D-MG PER.N41T *Plumbing and Electrical Inspections required THIS CERTIFIES THAT western Mass Siding & Roofing before Building Inspections has permission to install replacement windows Inspecti:)n on Site—Foundations situated on 58 Elizabeth St - John Graiff Inspecti,.)n 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 Mainte nce and Inspection of Building;; in the City of Northampton. Any violation of any of the terms above noted is an immediate revocation Insp-ction of Wiring—Finish of this permit.Expires six months from date of issuance,if not started. Buil cling 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 6 Install per Manufatturer s information: windows,vinyl siding,roofs and woodstoves Smoke Dei actors(Fire Department) ` . Other THIS CARD MUST B ISPLA�PWONSPICUO MISES �. Certificate of Occupancy _ Building Inspector