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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. f Alterations
NORTHAMPTON, MASS. 2.2 192 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location 1:203 idg,i9 S! Lot No.
2. Owner's name 14/A �2 II d C.ht/9�1°.S�/j'/, Address
3. Builder's name C/3%4,4ab Z C [{ �� Address /-3"A/Cd17— IP
Mass.Construction Supervisor's License No. X11 y ,?If Expiration Date 7
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 that the above statements are true to the best of his, her
knowledge and belief.
i
Signature ofresponsible app,icant
Remarks
�CtiArtP�,
B}° e ; °;fl Cr of 'Wnxfljttntpton . L
8 Z 3tsascyttrclta
} DEPARTMENT OF BUILDEgG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060 '
WORICER`S CON PENSATION INSURANCE AFFIDAVIT
(li�ns�/peraii ttcr.)
with a principal place of business/resideoce at:
(phooe")
(5v-,C---d6
do hereby certify, under the pains and peaaldes of perjury, that:
O 1 am an employer providing the following wor' cr's compensa von coverage for my
employees worming on this)ob:
(Insu=m 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) Qnszuanct- Conipany/Poucy Number) (Expim6oa Datc)
(Name of Contractor) (Insurance CompanyiPolicy Number) (Fxpira6on Date)
(Name of Contractor) (Insurance Compan},/Policy Nnmbur) (Expiration Date)
(Name of Contractor) (Iasu c-- Company/Poky Number) (E)Tiration Date)
(enaeh additmeml rboc{minoc_1y to ice} mnlvcmitioa pertaimng to all ocdraCOn)
I am a sole proprietor and have no one wori ng for me.
( ) I am a.home owner performing all the work myself.
NOTE:please be aware thxt v hi]o boaxownet7 v.bo employ pazom eo do rrzx:..e.,. occ coastrueiioa'or repair work oa x d.4C-tting of
not mote tbsn throo units is which the bomoowncr rc=dcs or ea tbo gouods xppuicauA thereto arc oet Scoavily eoaridcred to be
cmploym under tbo--k='m boa Act(G L152ts 1(5)�AWU=xtioa by x bomcow=for a 6o=c or permd may cvidmoc the
leg l rutua of an cmployor uodartbo Wocirda Compomat Aci.
I uadastaad Thai x Copy of thix m1-rd may be forwarded to tho Dopo tun ofLo�d A"66,O&offi.of Iawr.00e for tb.
covers gc vcrmficstioa aid that fad c to tomrc eovcrabo coda soetioa 25A of MGL 152 can lead to tbd impeaitioa of airmail Pcaaitics "
coaux=&of a•fine bf up to S 1,500.00 and/or imprisoamcni of up to ore year and civil pcmltics in the form of a Stop Work Order and a
film of s 100.00 r.day against mc.
D
Signed this _ S day of 1997 For dcpatma>;alts,00nly
Pcrm.it Number
Map;f Lot 4
Signature of Lt crmiucc
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:
I1. ALL INFORMATION MOST BE COMPLETED, or PERMIT CAN BE DENIED DOE TO
LACK OF INFORMATION.
This colw= to be filled in
by the Bnildiny pepnrtment
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 of Loading Docks
Fill:
(vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
G, is true and accurate to the best of my knowled e.
D-WE: APPLICANT's SIGNATURE
?" NOTE: luau flnoeAof a zonin
g permit does not relieve an applioant's burden to mply wltfl,,4kll-
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commisaion, Department of Publio Works and other applioable permit granting authorities.
FILE #
.Al. 2 319
File No
ZONING PERMIT APPLICATION (§10 . 2
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 'C--'0 WAXj0
Address: 1 S' daUR Telephone:
2. Owner of Property: L�/�1 f l/� KC 4j2`S/IY�
Address: 2 0 �lZi_J,� JV7 Telephone: Sj%U
3. Status of Applicant: ner Contract Purchaser Lessee
Other(explain): �-�
4. Job Location: 263 a��GA 5,
Parcel Id: Zoning Map# ✓ Parcel# District(s):
(TO BE FILLED IN:ZBUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
1
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 # 962582
t 31997
APPLICANT/CONTACT PERSON: J 915 CTQ
- ADDRESSM119NE:
PROPERTY LOCATION:
MAP �� PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
70NING FORM FH.T,FD 0111
Rnilding Permit Filled nnt
f
TIjF�,FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
r/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 Consery on Co Sion
Signature of Buildin ector ate
NOTE:issuanoe 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, Conservation
Commisalon, Department of Publio Works and other appiioable permit granting authorities.
t�
A�°��' "•e City of Northampton REQUIRED INSPECTIONS
} , BUILDING DEPARTMENT 1. Footings and Walls
2. Structural Components in Place*
3. Complete Building*
No.
707 Office of the Building Inspector
Zoning Form No. 962582 Date 7/29/97 Fee $20.00 Check# Money Order
Page, 25C Parcel 238 ,Zone URB Section 127 ❑ Yes ® No
BUI]LDING PERTVHT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Edward Corbett before Building Inspections
has permission to strip & reshingle roof Inspection on Site—Foundations
situated on 203 Bridge Street - Walter Kochapski Inspection of Plumbing—Rough
provided that the person accepting this pem-i 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 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 PLACE ON T7 PREMISES
4 Certificate of Occupancy
Building Inspector