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25C-198 (8) a � Z T a Z � o Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MASS. �'�� !3 19—921- Additions a APPLICATION FOR PERMIT TO ALTER Repair Garage 1. Location -57C7 /�G��l^ s G �v Lot No. 2. Owner's name Qe'wL L �,A� Q Address —S 6e- Af 3. Builder's name V-d(k J w ddress 14ZI Z t)tt�L�E— � A Mass.Construction Supervisor's License No. b�nl e2o� Expiration Date /Z/— g 4. Addition 5. Alteration y le) 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:- (Po The undersigned certifies that the above statements are true to the best of his, her knowledge and belief. QEC� Signature of responsible app icant Remarks MIAIf ! 5199T . � ��� t._ .0,0- 4aa ym�aa`t+eea , pi {7f �.w�,rarc:**w, mv�,m+',rmpe�mrs �ta�uw�art� 'a �iwa�s�RR l�arw,s(rna;�,trr,tap�mr+�ua nd' un%rwtsv a� 7flfn.t4»dd .Y i�'�w...nr�k,,:a,;t„ tiR.��'..AaR:F'e`a*'°..:.we ?i`.YAi.b9artnarkrX.M�A «�,F'.' , k }P 4 Gl its of 'Naztl amptan z r �aS58ChIi8t115 < , DEPARTMENT OF BUILDING INSPECTIONS t 212 Main Street a Municipal Building 'o�H SV•�,' Northampton, Mass. 01060 wORKEW S COMPENSATION INSURANCE AFFIDAVIT MILL RIVER BUILDERS Oipermittm) with a principal place of business/residence at: 164 RIVERSIDE DRIVE,NORTHAMPTON,MA 01060 (phone#) I'R c/3 (street/city/statrlrip) do hereby certify, under the pains and penalties of perjury, that: �c) I am an employer providing the following worker's compensation coverage for my employees working on this job: Ccr-4r\Ee-c.AL DLAt- � C l3 697 - 'R 14 ��7 (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) (Expiration Date) (Name of Contractor) (Insurmce Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional sheet ifneoenuy to include information pexiaining to all oodraofors) ( ) 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 persons to do maiatmance,conshmWoo.or repair work on a dwelling of not mace than three units m which the homeowner resides err on the grounds appurwmatherdo ate not generally considered to be employers under the work eez compensation Act(01,1524s 1(5)),application by a homeowner for a lice nae or permit may evidence the legal status of an employer under the Worker's Compensation Act. I understand that a copy of this stattmad may be forwarded to the Depart ncot;of Irrdtrstrial Aocidanti Office of Ins"am for the coverage verification and that failure to secure coverage under section 25A of MGL 152 can lead to the imposition of mmtnal penalties consisting of a fine of up to$1,500.00 aadlor imprisonmett of up to one year and civil penalties in the form of a Stop Work Order and a fim of$100.00 a day against me. Signed this_Z �—__day of /N 19f-'° For depiatrnental sere only r7 ' - Permit Number �_..-._. Map# Lot# Signahue i ermittee See reverse side for instmetionv 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 X IF YES,describe size,type and location: 11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. This cols= to be fillad 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 of Loading Docks Fill: 4 vo1.-ume--& location) 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. D70B .S �3 � �" APPLICANT's SIGNATURE � NOTE: iss anoe fat a zoning permit does not relieve an a g p pplioanYs burden to oompfy wit",,all- zoning requirementa and obtain all required permits from the Board of Heafth, Cohaervistion Commisaton, Department of Publio Works and other applicable permit granting authoritlas. FILE # MAY f 4 W f File No.'7 6,:z7�4z ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant. E:D Address: //oil Z OIZ-5` k4..�z�9--• 1�'J��Telephone: S�6 2. Owner of Property: 24a'f':�z Address: 5 Telephone: 3. Status of Applicant: Owner Contr ct Purchaser Lessee (explain): X- Other �w'\ 4. Job Location: S� /tL?�¢--�� SheEk—�7 Parcel Id: Zoning Map# Parcel# 19F F District(s): (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property 17-116 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/Vadance/Finding ever been issued for/on the site? NO DON'T KNOVV_ ,�, _ 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`_X__ 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) to P FILE # 9 6 22 4 a 1,1� v` MAY 1 41997 - APPLICANT/CtONTACT PER.S N: UAI J: AD.DRESS' ?qE: z, PROPERTY LOCATION: MAP ©?§"C' PARCEL: ZONE THIS SECTION FOR-OFFICIAL USE ONLY: PERMTT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM VILLED DITT i� cio - T4W of Construction- New Cnnstriirtinn Afitfitinr ArresynryStriiCtime THVOLLOWING 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-Bd of Health Well Water Potability-Bd Health !Pe ''tfro onseUat' o Signature of Building for Date NOTE:Issuance of a zoning permit does not relieve an applioant'a 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 applicable permit granting authoritles. ..° may City of Northampton REQUIRED INSPECTIONS e 1. Footings and Walls a BUILDING DEPARTMENT 2. Structural Components in Place* 3. Complete Building* Office of the Building Inspector No. 401 Wiring Form No. 962248 Date 5/16/97 Fee $40.00 Check#3990 Page, 2sr Parcel 198 ,Zone URC Section 127 ❑ Yes ® No BUI]LDING PERNM *Plumbing and Electrical Inspections required THIS CERTIFIES THAT Mill River Builders/Ed Krutzky before Building Inspections has permission to remodel existing bathroom/laundry Inspection on Site—Foundations situated on 59 North St - Bruce MacMillen 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 Smoke Detectors(Fire Department) Other THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS P CE ON PRE ISES Certificate of Occupancy Building Inspector �� �� � F b 3 t wY ,�'. ,f � x' � '... - �_ _� .. .. „ r.�. i �: P �, �*� ,: .. „4 ...� �. �" $: City of Northampton REQUHZED INSPECTIONS e 1. Footings and Walls BUILDINGDEPARTMENT z. Structural Components in Place* 3. Complete Building* No. 40l Office of the Building Inspector Zoning Fonn No. 962248 Date 5/16/97 Fee $`10.00 Check#3990 Page, 2SC Parcel 19R ,Zone URC Section 127 ❑ Yes ® No BUI]LDING *Plumbing and Electrical Inspections required THIS CERTIFIES THAT Mill River Builders/Ed Rrutzky before Building Inspections has permission to remodel existing bathroom/laundry Inspection on Site—Foundations situated on 59 North St - Bruce MacMillen 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 A provisions of the Statutes and the Ordinances relating to the Construction, Inspection of Wiring—Rough s/ / 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 71d-/5 of this permit.Expires six months from date of issuance,if not started. Building Inspection—Rough QJ'Pr 6-- a 9-q 7 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 Q k. 7-1j-!F7_440-z,7 Smoke Detectors(Fire Department) Other THIS CARD MUST BE DISPLA IN CONSPICUOUS PLACE ON f PRE ISES Certificate of Occupancy Building Inspector