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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
,,./
NORTHAMPTON, MASS. 19� Additions
Repair
• APPLI -ATION FOR PERMIT TO ALTER
Garage
1. Location Lot No.
2. Owner's name / l b Address
3. Builder's name t / Address T' TV
Mass.Construction Supervisor's License No.— Z 5` 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
13. Siding house
14. Estimated cost:- `
The undersigned certifies at t a v s cmcn a true to the best of his, her
knowledge and
Y
Signature of responsible app icant
Remarks
g'CI�MP�.
�O 0
�x of 'Wart4a111ptan
NOV31997lasaxrElnsrtta
DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
up
L ID
(licensee/permittee}
with a principal place of business/residence at:
(phone4)___2 /-/`3 7 7
(street/ state/np)
do hereby certify, under the pains and penalties of pegury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees worlflng on this job:
(Insumnee 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) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(snarls aA3&doo2l sloes ifneccmuy to include information pertaining to all oocdractots)
J�J 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 while homeowners who employ parso=to do mairdc ancc�construction or repair work on a d miling of
not more than throe units is which the homeowner rides or on the grounds appurtenant thereto arc not generally ooandered to be
employers under the worker's compensation Act(01,152.As 1(5)),application by a homeowner for a license or permit may midenoe the
legal status of an employer under the Woricces Compensation Act
I understand fl u&a copy of this statement may be forwarded to the Deparmxo2 of Industrinl Amdn&Offioe of Inwcance for the
coverage verification sad that failure to secure coverage under section 25 A of MOL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to S1,500.?( and/or imprison of up to one year and civil penalties in the form of a Stop Work Omer and a
fine of S 100.00 a day against tno.
Signed this y f 1997 For departmf use only
Permit Number
Map#_ Lot#1
Si icenseelPermittee
10 Do any signs exist on the property? YES NO V
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 MIDST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This column to be filled in
by the Building Department
(Required
Existing Proposed By Zoning
I 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
#
"of Loading Docks
Fill:
4 volume -& location)
13 . Certification: I hereby certify that the infor at ` n nta ' d herein
is true and accurate to the best of my kno �
DATE: / APPLICANT's SIGNATU
NOTE: Ila n of ai zoning permit does not relieve a ioan s burden to oomply with all
zoning utrements and obtain all required permits from the Board of Health, Conservation
Commission. Department of Publio works and other applioable permit granting authorities.
FILE #
1997
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: !r <:;;' .�
r
Address: 5;T' A/Q00//'0tphone.
�
f
2. Owner of Property:
Address: Telephone:
3. Status of Applicant: Owner _—Contract Purchaser Lessee
Other(explai
4. JAM Locat ion: / �� •��-.r-- ��
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
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.
S. Has a Special Permit/Vadance/Finding ever been issued for/on the site?
NO DON'T KN^:^: 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)
' # ^'
NOV 3997 FILE
APPLICANT/CONTACT PERSON: >
ADDRESS/PHONE: e
PROPERTY LOCATION: —
MAP__,, PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
.ENCLOSED REQUIRED DATE
7.ONTNG FORM FH.T.FD OUT
Fee Pnid
111nilding Permit Filled nvit
Fee Plid L, .,�.
Type of ConRtriietinn-
Adfiit;nn to Existing
TIJ�OLLOWING 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 Conservatio ommission
Signature o w] g r Date
NOTE: Issuanoe of a zoning permit does not relieve an nppiloant's burden to oomply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applionble permit granting authoritles.
City of Northampton REQUIRED INSPECTIONS
} i
BUILDING 1. Footings and Walls
DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
No. 1063 Office of the Building Inspector
Zoning Form No. 962985 Date 11/6/97 Fee $20.00 Check# Money Order
Page, 25C Parcel 162 Zone URB Section 127 ❑ Yes ® No
BUI]LDINGPERTVHT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Steve Salerno before Building Inspections
has permission to install replacement windows Inspection on Site—Foundations
situated on 12 Orchard St — Stan Kochapski 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 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 DISPLAYED IN A CONSPICUOUS PL CE ON T P ISES
Certificate of Occupancy
Building Inspector