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25C-150 (4) Sbo 9 ? a� f 1,. w i .fl 70 � < n cDi� � C: o •' cn Z N -3 p � Zoning , Miscellaneous Addition epai Alterations,etc. Tel.Nor.2/c,6 ��'��� ` Alterations MASS. Additions NORTHAMPTON, � —' .� � 19� APPLICATION FOR PERMIT TO ALTER Repair Garage 1 3 ( ., 1. Location �-� 'r Lot No. — 2. Owner a's name Address 3. Builder's name Address r Mass.Construction Supervisor's License No. L/ `T a 9' Expirati n Date_f� 9 4. Addition 5. 6. .. 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:- 30-00, The undersigned certifies that the above statements are we to the best of his, her knowledg and belief. S ture of responsible app icant Remarks S E! y a SEP Z g �, 1997 aeaar}lusrtta m OF 8U 1l0?Fa C;IPi S'�f jd�E ARTMENT OF BUILDITjG INSPECTIONS DEPT StCttl;��,��.r�� 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT (licenserJpermittee} with a principal place of bus' ess/residence at: (phone#) (stt ty/stairizip) do hereby certify,,under the pains and penalties of perJury, 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 hired the contractors listed below who have the following worker's compensation policies, (Name of Contractor) (Insurance Cortipany/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Poky Number) (ExTiration Date) (Name of Contractor) (Instran(-- Comparry/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additicrzal sboci ifneccnary to mcludc nforwaIIoa pataiuing to all ocatrndon) I am a sole proprietor and have no one working for me. I am a home owner performing all the work myself. NOTE:please be aware that whilo homeowo=who cmplay perrow to do maim,,•n a won or repair wore on a dwmlling of not moeo than throe suits is which the homeowner rtudca or on tha,cynund3 appudeaaui thwdo are not gc=ully considered to be employers under the worker's c=pcns4oa Act(GL152,s3 1(5)),am ca6oa by a homeowner for a licrnse cc permit may nidcaom the legit stabu of an employer under the Waicor's Compeoution Act I understsad thai a copy ofthu rutemsat may bo fociwarded to tho Dqp to c of Industrial Accidea&Ofoc of In=r for the coverage vaification and that&duro to acatre coves undo section 25A of MOIL 152 can lead to the imposition of criminal penalties comisting of a fmc of up to 51,500.00 and/or imprisoamcz4 of up to one year and civil pcn&Wa is the form of a Stop Work order and a fins of 5100.00 a hay agninA me. Signed this _day s 1997 For dial sire caly ' permit Number Map# Lot# t�ture of i t tce 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 colw= to be fill-ed in--e- 14,6> �t� by the Enilding 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) # of "Parking Spaces t 6. f Loading Docks Fill: voiume -& location) 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowle4ge. " .y DATE: —r,Z APPLICANT's SIGNATU ' f _ NOTE: Issuanoe of a zoning g permit does not relieve an applioa s ply with .+pill- zoning requirements and obtain all required permits irom the oard of ealth. Conservation iCommisaion, Department of Publio Works and other appiiomble permit granting authorities. FILE # 9 4 S� 2 91991 gU1LDMG INSPE0O S DEPT AMPtO�y MA O1G6 w. ' File NO. ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: Address: Telephone: 2. Owner of Pro erty: Address Telephone: 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): z sc 1 4. Job Location: ✓� Parcel Id: Zoning Map# � � Parcel# District(s): C/= (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure[Property 6. D�ption of Pro osed UseM roject/Oc bon: a add'' nal sheets if ne a ): 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 # �� APLC kCT PERSON: PROPERTY LOCATION: MAP _ C PARCEL: /S-cl ZONE THIS SECTION FOR-OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FH,T,FD OUT Fee Pnid Building Permit MUM n1vt irilided- r�- YC7 7 THE F9LLOWIN 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 Appral-Bd of Health Well Water Potability-Bd Health Permit from Conservati ommissio /--�C,7X2 Signature of Building or Date NOTE:Isauanoe of a 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, Conaervation Commission, Department of Public Works and other applicable permit granting authoritles. City of Northampton REQUIRED INSPECTIONS A BUILDING DEPARTMENT 2. Struccttural Components in Place* 3. Complete Building* No. 928 Office of the Building Inspector Zoning Form No. 962830 Date 9/30/97 Fee $40.00 Check# 4088 Page, 25C Parcel 150 ,Zone URB Section 127 ❑ Yes © No BUI]LDING PERNffl * Plumbing and Electrical Inspections required THIS CERTIFIES THAT Tom Boyle before Building Inspections has permission to repair front porch Inspection on Site—Foundations situated on 21-23 Orchard Street - Frank Bilsza Inspection of Plumbing—Rough provided that the person accepting this pen-nit shall in every respect Inspection of Plumbing—Finish conform to the terms of the application on file in this office, and to the Gas Inspection provisions of the Statutes and the Ordinances relating to the Construction, Inspection of Wiring—Rough Maintenance and Inspection of Buildings in the City of Northampton. Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring—Finish of this permit.Expires six months from date of issuance,if not started. Building Inspection—Rough Note:A certificate of occupancy will be issued by this office upon return Insulation Inspection of this card signed by the Plumbing,Wiring and Building Inspectors. Building Inspection—Finish Smoke Detectors(Fire Department) Other THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON Tly PREMISES Certificate of Occupancy Building Inspector WX r `'_ 1p All WON N oil wl Ms "fakup nap f, iv k �si" e$rte a ' �az i x y ,�, Ya,�-'xrm OWN 0 "WO rz W A MY w C N } It nag a a 'yfiaa ,a*5� 1w}SN it q _ ft S Y 'S°` � Y`d :'� 'Y:£:T�' "i � 4 }CY 3§ "}kW =swum P. 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