Loading...
25C-163 > 3 p O Cnn .. ' Z m CC `� � � � ' cNn O Q z � o -� Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel o. Alterations NORTHAMPTON, MASS. 19 r" Additions ' APPLICA ION FOR PERMIT TO ALTER Repair / Garage 1. Location h a T Lot No. 2. Owner's name ,-C Address —G o,� T a 3. Builder's name e0-0rH sic'JUC-U /boo C Address 6 3 7 ��` f_. Mass.Construction Supervisor's License No 0 3 Expiration Date 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 �u/�"au W /?0 o l� Sly,, ,,, C 13. Siding house 5—t nc, „n �6 BA"ar 14. Estimated cost 173). 0U The undersigned certifies that the above statements are we to the best of his, her knowledge an lief. Signature of responsible app ican! Remarks 9 � j�blxssacllnrrctts IEPT Gr z "`' DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street a Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT ,F (IlcenSwipermittee) with a principal place of business/residence at: s �e (phone#) �T*C ��2 (st1-eet/city/st ap) 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 Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Ex#mtion Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach addition!short ifnoD=mjLry to inchrdo information pertaining to all ooa radora) ( Irani 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 while homeowners who employ pc=m to do mamte=tce,oxrgr ction or repair work on a dwelling of not more than throe units is which the homeowner resides or on the groins appurtenaat thereto are not gcocrally 000ndered to be employers under the-uke's co-pen:u4ca Act(GL152,ss 1(5)),application by a homeowner for a license or pcfmd may evidence the legal status of an employer under the Workees C.ompamation Act I undesuatamd that a copy of this statement may be forwarded to the Depwtrtx 2 of Industrial A=dw&OfSoo of In9u vmm for the coverage verification and that failure to&==coverage under section 25A of MGL 152 can lead to the inl;md oa of aiminal penalties oomisiin of a fine of up to$1,500.00 and/or of up to one year and civil penalties in the form of a Stop Work Order and a fine of 5100.00 a day against mc. For deputmedsl use Only L, Permit Number �� Map# _Lot# SiVmbire of Licensee-no then e 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 cola= to be fiZLed 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 &paved parking) # of -Parking Spaces f of Loading Docks Fill: 4 volume-& location) 13 . Certification: I hereby certify that the information containe herein G is true an accurate to the best of my knowledge. DATE: APPLICANT's SIGNATURE r NOTE: las an a of a zoning permit does not relieve an appiloant's burden to oomply With 4111 zoning requirements and obtain all required permits from the Board of Health. Conservation Commisslon. Department of Publio Works and other applloable permit granting authorities. FILE if APR 6XIM File No. Pt ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applican . a T r o f Address: e 3 4 — Telephone: 5 kC- 2 2. Owner of Property: Address: r r Telephone: 3. Status of Applicant: Owner L--contract Purchaser Lessee Other(explain): 4. Job Location: Parcel Id: Zoning Map# Parcel# District(s): ti-- (TO BE FILLED IN BY THE BUILDING DEPARTMENT' Q� 5. Existing Use of Structure/Property HouS 3 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) ( L �5 (1 °�•. a FILE # J C' .� C> 03L) APPLICANT/CONTACT PERSON: z )EPI T r ADDRESS/PHONE: e PROPERTY LOCATION: MAP �'� PARCEL: ZONE THIS SECTION FOR.OFFICIAL USE ONLY: PERMUT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM Fn.T.FD OUT Fee Pnid T OLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATIOM 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 Ei.":;Approval-Bd of Health Well Water Potability-Bd Health :. Permit from Conservation C mmission */5 /.__._ . Signature o u o .,.'y to NOTE: 1sau. of a zoning permit does not relieve an applloant's burden to oompty with all zoning requirements and obtain all required permits from the Board of Health, Conservation Commisalon, Department of Pubiio Worka and other applioabie permit granting authorities. City of Northampton REQUIRED INSPECONS TI } ' 1. Footings and Walls N BUILDING DEPARTMENT 2. Structural Components in Place 3. Complete Building* No. 1436 Office of the Building Inspector Zoning Form No. 963380 Date 4/7/98 Fe($20.00 Check# 2018 Page, 25C parcel 163 ,Zone URB Section 127 ❑ Yes ® No BU]IL"ING PERTVHT a * Plumbing and Electrical Inspections required THIS CERTIFIES THAT Western Mass Siding & Roofing before Building Inspections has permission to strip & shingle garage roof & siding on dormer Inspection on Site—Foundations situated on 140rchard St – Richard carnall Inspection of Plumbing—Rough provided that the person accepting this pem7 t 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 inunediate 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 P LACE ON T PRE ISES Ce.-6ficate of Occupancy Building Inspector (� 7 � . �;��� �� •'' ,�' `,;�.. #,:= .,,- i . #;.'• � tt,. �: .# +� ,; �, , `�`. C lt of Northampton REQUIRED INSPECTIONS ' 1. Footings and Walls BUILDING DEPARTMENT � 2. Structural Components in Place* 3. Complete Building* No. 1436 Office of the Building Inspector Zoning Form No. 963380 Date 4/7/98 F420.00 Check# 2018 Page, 25C Parcel 163 ,Zone URB Section 127 ❑ Yes No BUILDING * Plwnbing and Electrical Inspections required THIS CERTIFIES THAT Western Mass Siding & Roofing before Building Inspections has permission to strip & shingle garage roof & siding on dormer Inspection on Site—Foundations situated on 140rchard St - Richard Carnall Inspection of Plumbing—Rough provided that the person accepting this permit shall in every respect Inspection of Plumbing—Finis;,, conform to the terms of the application on file in this office, and to the Gas Inspeon 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 ** Install per Manufacturer's information: windows,vinyl siding,roofs and woodstoves Smoke Detectors(Fire Department) Other THIS CARD MUST BE L+ISPLA D W A CONSPICUOUS P WE ON PREMISES Certificate of Occupancy Building Inspector