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25C-147 (2)
> 2 m a d 3 O vl .. r- Z m Z v� O Z > Z J. ^: m c M Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Y 738? Alterations NORTHAMPTON, MASS. /Vat/� :� q 19 YT Additions APPLICATION FOR PERMIT TO ALTER Repair a Garage 1. Location -27 Arc t-�a ld 'Tt Lot No. 2. Owner's name L t o v,e( Cu It ev\ Address --2 7 C C G-,a wJ 2t. 3. Builder's name n Avid, jq. 7,7dk✓)SoA Address 41N 8na, WI) rccl• Gt/r'IIia�tbvX01.N1>9 MCon Supervisor's Lnicense No. C1SS`�43 Expiration Date G —�9 — aQo© 4. hod iate I�ci`^^,(� 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-'�'3) 0Q The undersigned certifies that the above statements are we to the best of his, 1 knowledge and belief. Signature of responsible appicant Remarks Ho ca.S'-e 14' v x Pr a x 8 Z%c,str Pr De F'r lea ad rv'iLr Ila i ; i5 1998 '� y X �K1iMf PT'. O Crxk iafi�zttnc �it ',i � ,�xsfxdinsctta 'tl,'vf 4- 4 DEPARTMENT OF BUILDTXG INSPECTIONS i212 Main Street ' Municipal Building Northampton, Mass.• 01060 W0PJCER"T COMPENSATION*INSURANCE A t AVrT I. of A JaL"Nsvn (li�nscc/Permi tttx) wit-! a principal placc of business/residence at: . (stlr...1/ci t)'/stairla p do hereby certify, under the pains and penalties of perJury, that: O I am an employer providing the folloNviog worker's compensation coverage for my employees worl-6ng oa this)ob: (Inswzna: Compaay) (Policy Nu L--0 (Expiration Dale) ( ) I am a sole proprietor, general contractor or homeowner (circ)e one) and have hired the contractors listed below-who have the following worker's compensation policies: (-1Iatme of Cont u,cwr) (Ins,:-sc:.Cornoaay/Potic;Ntuni:cr) (xpiradoe Datc) (�ia�nc of Contractor) Mss::acc Como vnvPo!ic \unccr) (Expin6on Date) (Name of Contractor) (Insurancz- CompL i /Policy Number) (Ea.-piration Date) (Name of Contractor) (Insurance Compaay/Policy Niumber) (Expiration Dale) (ettadt:.dditiooa!r'_•.rct if ncc—au to iodudc pat j,n to all oodnCO:�) QQ I atn a sole proprietor and have no one wor4•ano for lne- ( ) I am a home owner performm,- all the work myself. NOTE:phase be aw2m that wltilo boamcowvm w{w c splay perTaw to do= tr+ •+n coo-z-,;cxioc-or rcpac work oo a deviling of not mock th n dx oo uaiu is wfik!a the bocnoowocr mi'o oc oo cba v-oundt apputcaat tbceco arc ooc cry oowidarod to be cmploym undue tbo ww ce-x°Oaqc='L"n Act(GL152 a t(S)),,application by a bomcowvcr for•Gcrose a permit may CV-: ooe the legal ri—,oran aatployK under the Worlcoea co�o.Act. I aadgstaad the a Dopy ottbia ctztammt may M lorwvd.d Lo the Dapartmao[of lndaatriJ Aood�f Oboe of Imuv+oo�foe tb. oovaage vcrifieztioa aM that U=to seauc eovcmto under sec6oa 25A of MOL 151 can lad to tbd impasiioo of tximiad peaaitia ooasistiaa ora$mebrup to s 1,�g3,go aodloc Lmpcao®ccd otup to ooe yor and oval Pcmwc:is the form of•Stop Work Order Lod a fim ofS160.00 a day:gaias! zsv of L:ioi�scrlPmcei zaittoc [,F o dyj4 . o oo1Y PmNw4bcr si 10 Do any signs exist on the property? YES NO t/ 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 COMPLE'T'ED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. Thi= columa to be filled in by the E+nildingnrtmen t Required Existing Proposed By Zoning Lot size Frontage Setbacks - frnnt - side L: R: L: R: - rear --- Building height Bldg Square footage %Open Space: (Lot area minus bldg &payed paring) # of Parking Spaces # '6f 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: - Q APPLICANT's Sl'GNATURE NOTE: Issuanoa of a zoning permit does not relieve an applicant's bu en to oomply Wlth~all zoning requirements and obtain all required permits from the Board of Health, Conservotion Commisslon, Department of Publio Works and other applioabia permit granting authorities. FILE # , r NOV 2 4 i �L) Fi 1 e No. �/ / ZON- G PERMIT APPLICATION (§10 . 2) -PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: f) 4v,d A . WVb v1 Scy d1 Address: qLl A i.-,a,— l.'I) Qc1. /1�1/a,-SKA Telephone: 2. Owner of Property: Cca ll-e A Address: ---� 7 Q et Telephone: 3. Status of Applicant: Owner L", Contract Purchaser Lessee Other(explain): 4. Job Location: 0'2 Oc(ncnvd r Parcel Id: Zoning Map# �(' Parcel# District(s): (TO BE FILLED IN BY THE YUILDING DEPARTMENT) 5. Existing Use of Structure/Property Ho—'\-,P- 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): 84 n d i ran ,ra.Mp 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. 6. 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) r File#BP-1999-0535 APPLICANT/CONTACT PERSON David Johnson ADDRESS/PHONE P O Box 390(413)268-7389 PROPERTY LOCATION 27 ORCHARD ST MAP 25C PARCEL 147 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Type of Construction: New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Occupant Statement or License 4 3 sets of Plans/Plot Plan THE LLOWING 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 Board of Health Well Water Potability Board of Health Permit from Conservation Commission Signature of Building fficial Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. Department: Reference No: BP-1999-0535 ............••....•....•.....•..... Building, Electrical & Mechanical Permits Fee Type: Receipt No: Building- Renovation REC-1999-001455 .............................................................................. ......... ................ ..................... Paid By: Paid in Full On: David Johnson Tue Nov 24,1998 ................. ....................................................................... .•----.•... ...... Received By: .C h eck.No:................... .Linda Lapointe 259 ......................................................................................... ...........•....••...••.........•....• DEPARTMENT'S COPY Amount: $40.00 ----------------- --------- Dli'PARTM11.'.N'*1' FlLE COPY 27 ORCHARD ST CITY OF NORTHAMPTON BUILDING PERMIT Owner's pulling their own permits or dealing with unregistered contractors for applicable work do not have access to Guaranty Fund(MGL 142A) Issued: Permit No: Inspector: Tracking No.: Fee: BP-1999-0535 $40.00 GIS #: Map Block: Lot: Address: Zoning: Use Group: Lot Size: 4526 27 ORCHARD ST URB 4007.52 Contractor: License Type: Insurance: David Johnson CSL Address: License No.: Insurance No.: P 0 Box 390 055903 City: State: Zip Code: Phone: WILLIAMSBURG MA 01096 (413) 268-7389 Proiect No: Category of Work: Const. Class: Cost Estimate: JS-1999-1011 alteration-addition $3,100.00 Description of Work: TEMPORARY HANDICAP RAMP GeoTIVIS&1997 Des Lauriers&Associates,Inc. Signature: