06-044 (5) 2
70 'v
< n•
v � o• �
� � m
3 O Z rn
z _ �• O
a
A
/ Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.`���� ��� Alterations
NORTHAMPTON, MASS. 9.1 Additions
a APPLICATION FOR PERMIT TO ALTER Repair
a Garage
1. Location 2k� � t������ �- �� s 4, Lot No.
�
2. Owner's name cy IZ-''_ ,, A r1 ,>['oi -6V tt c `1 Address `1�sas1C
3. Builder's name �z I a,a ez-- Address /1,
Mass.Construction Supervisor's License No. 04S-4-0(, Expiration Date
4. Addition
1 �
S. Alteration T,1A/l �CC�7�ar! L✓��2 k/' 'ir�11 ? �Lf
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 lye t✓ 1'Gs9Al
14. Estimated cost:- )3 31 .0 a
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
Signature of responsible app icant
Remarks
200(1�ANpTO
�� 9
JAN 91998 (r tf of wart4ailtptlln Ix
� � �xssttd)nsctta
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060 '
WORKER'S COMPENSATION INSU'RA_NCE t 1 AVTT
Oi c' n_ pci mi ttee)
with a principal place of businesslresidence at:
G1e r�F1370 (phoneyO 6.?S_ 0/6 0
(strcet/ci /stalrl7ip)
do hereby certify, under the pains and penalties of pefulry, that.
O I am an employer providing the following workers compensation coverage for my
employees working on this job.
(Insurance Company) (Policy Number) (Expirarion 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:
6�on-C
(Name of Contractor) (insurance Company/Policy Nurnbcr) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insu=c: Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(atiarh additional shed if noccauy to include informitioa pc:tn Wing wall coah-aaon)
I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please lx await tlui w)-,ilo homcowDcta who cmplay per:ow to do maiaicaancS coast jcfj ar repair work on s dwelling of
not mom tban thma units in which the twmoowucr rmacs c oa tho growls appurteaani Lb«do arc Dot gaxrally oowt rcld to ba
anployers under tho woctta's oration Ad(GL152,ss 1(5)),npplitttiou by a homeowner for a U-05C a permit—Y cvidcace the
legal ctniva of an omployec under the Wort z Conspcmation Act
I undassaad t6.d a copy of this cEalcmms may bo f.wnrdod to tho Dtpaivncni of a1 A ccid&Of —of I.'u`}°°°for 1b,
oovaxgo wnficaiioa and that failure to scatre covcrago under socUon 25A of MGL 152 can lad to tba impoortsoa of criminal penalties
consisting of a find of up to S1,500.00 aad/oe imptizommcat of tip to ane y1w and civil panYtia in the form of a Slop W orlc Order and a
fine o(5100.00 a day againA me.
Signed this _____day of 1997 For dcpsrt=nW—c01Y
Permit Number
Map# I of
Si o iemseelPertt�i-tom
�i
i
i
tl
.1w, ` g �
doll
i;
;{ 12/K
en
f,
i
`i
"i
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 colnmm to be Pillad in
by the Building Dapartzmnt
I (Required I
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
&Paved parking)
# of -Parking Spaces
f of Loading Docks
Fill:
-(vol-time -& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: ( g APPLICANT's SIGNATURE
NOTE: Is ua oe of a zoning permit does not relieve an a Iioant's burden to oompty witFr $tl
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission, Department of Publio Works and other applioabla permit granting authorities.
FILE #
r.._ ,
s : File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: r>?
Address: `7 C D3�S 3-11 6115,1V Telephone:_ Os-- cy/o
2. Owner of Property: p
Address: 2qt yo i!f71/,��{ - L! M_Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
>C Other(explain): L,'ce,1_5C J 671' c ;/—
4. Job Location: 2Lr'�
Parcel Id: Zoning Map# �P Parcel# �i District(s):� lif
(TO BE FILLED//IN BY THE BUILDING DEPARTMENT)
5, Existing Use of Structure/Property 'J r',/ . "".�— c''�LC c,�L'jf'ns _
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
rfltl ,ft""' J. Fj2M& t-11 3 �y yYc����.4 r„P.�� �'c,✓ ��► /�I����/` l,✓�/�
7. Attached Plans: Sketch Plan X 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 # " `" ) J �
15 la �=
CA ONTACT PERSON: /� --�
AAW
D . .HONE ZL
>, q�, u,
PROPERTY r nr A"'T1,1. �•,
EL: ZONE �J
f ECTION FOR-OFFICIAL USE ONLY:
.hsL :NHT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Ownerffirril-pant Statement
Gc
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
_le'A'pproved 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
I/
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 Ilse a ' C ssion
Signature of ruilding Inspector Date
NOTE:kmuanoe of es 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
Commisslon, Department of pubiio Works and other applioable permit granting authoritles.
A{o '�s City of Northampton REQUIRED INSPECTIONS
' BUILDING DEPARTMENT 2. Footings turl and Components in Place*
• 3. Complete Building*
No. 1220 Office of the Building Inspector
Date 1/12/98 Fee $40.00 CfieCk# 1311
Zoning Form No. 963153
Page, 6 Parcel 44 ,Zone SR/WSP/WP Section 127 ❑ Yes ® No
BUI]LDINGPERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Jon Romer before Building Inspections
replace rotted sills,siding,& frame in reception
has permission to window on interior wall Inspection on Site—Foundations
situated on 241 Haydenville Rd - Western Mass Girl Scout council 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 PLACE ON 71WREMISES
Certificate of Occupancy
Building Inspector