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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. j� E,--Tel.No. Alterations
NORTHAMPTON, MASS. / E 19 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
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1. Location r�, ., ;p�, Lot No.
2. Owner's name Address --
3. Builder's name J 1�1'�j I�H{ f' Address
Mass.Construction Supervisor's License No � Expiration Date
4. Addition r
5. Alteration
6. New Porch
7. Is existing building to be demolished? ft�
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.
L'ISignature of responsi le app icant
Remarks lL cil-i� -1
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81997 aSbRrl,nsrtta
m DER 1RTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building
e1 V
Northampton, Mass. 01060
WORKER'S COMPENSATION INSUIUNCE AFFIDAVIT
censeeJpermittee)
,Agt�h a principal place of business/resid`eace at:
C L/ & U ? n (phone#) (�'I 02
(s vii stalrJap)
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 Daze)
( ) 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/Pobcy Number) (Expiration Date)
(Name of Contractor) (Insuran(—_ Compaay/Pobcy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(atiadi additioml dioe if noocuary to iachidc inf x oa pertaimng to all oc"r rs)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:ptcaao be await that Whilo homcowmn who employ persom to do ma^+tm*or coostvction'or repair work on a dwelling of
not at=than thtao emits in which the homeowner resides oe oa tb o Vwx ds appurteuaat th=w arc not gc*=4 comidard to be
employeta under tbo woriue z ooW—ation Act(GLI52,ss 1(5)),application by a homcowna for a Go=c oc patnd may evidence tbo
legal statu of anemployee underthe wodcoea compoosstion Acf
I undaattad that a copy of this tut—cat may be forwarded to the Dtpwu=c t of Indaut d Aaadea&Moo of Imuranoa for the
coverage verification and that failure to soatre covctngo trodcr section 25A of MOL 152 can kad to tba impoeition of criminal penalties
oomisC g of a f nc of up to 51,500.00 and/or of tip to one year and civil Passion in the form of a Stop Work Otdar and a
fine of 5100.00 a day against tna
Signed this / day of 1997 For dial use only
Permit Number
�J--� Map# Lot#
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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 V_
IF YES,describe size,type and location:
11 . ALL INFORMATION MAST BE COMPLETED, or PERMIT CAN BE DEN1"ED DUE TO
LACK OF INFORMATION.
Thin column to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size , r-j
Frontage 1 ov J '
Setbacks - frnnt '
- side L: S/ R: L: SCR: I S
- rear ---
Building height
Bldg Square footage Ir 6 � n
%Open Space:
(Lot area minus bldg
&pax,ed parking)
# of 'Parking Spaces
# 'of Loading Docks
t
Fill:
-(volume -& location)
13 . Certification: I hereby certify that the information contained herein
1r is true and accurate to the best of my knowledge.
DATE: APPLICANT's ShGNATURE
NOTE: lasu f zoning permit does not relieve an a pli ants burde t oomply Witty 4111
zoning requtr ments and obtain call required permits fro a Board of H Ith. Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
4'
DEC 81997
File No.
n+a r r
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
it__ E
Name of A p li an L , 41ow
OJ
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P,ddre Telephone: �-�7__�
2. Owner of Property: � �
Address: Telephone:
3. Status of Applicant: Owner _Contract Purchaser ''V Lessee
Other(explain):__-
4. Job Location: 3
Parcel Id: Zoning Map# / rT Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
4
5. Existing Use of Structure/Property A ".f I
6. Description of Proposed UseNVork/Project/Occupation: (Use additional sheets if necessary):
-;)r�e_ , I 1z -4'J" "7YC re,
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7. Attached Plans: Sketch Plan V 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_ V 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)
x FILE
�
rya� DEC ",97
APPLIC /CONTACT PERSON:
PROPERTY?LOCATION: 67
MAP r° /? PARCEL: %' ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM VH.T,FD OUT
Fee Plid
Rnilding Permit Filled mit
Fee Pqifi P3
Type of Constmirtion*
Addition to Existing, —,,14,
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TG LOWING 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 Conservation Co mission
Signature of Bull ec r ate
NOTE:lusuanoo of a zoning permit does not relieve an applioant's burden to comply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applioable permit granting authorltles.
Ado �s City of Northampton REQUIRED INSPECTIONS
1. Footings and Walls
BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
No. 1151 Office of the Building Inspector
Zoning Form No. 963083 Date 12/10/97 Fee $64.00 Check# 1233
Page, 31A Parcel 97 ,Zone_ILR�LWP Section 127 ❑ Yes ® No
BUI]LDINGPERMI F I
*Plumbing and Electrical Inspections required
THIS CERTIFIES THAT James Phaneuf before Building Inspections
raise section of rootiadd door to deck,new entry
has permission to & (2) new windows Inspection on Site—Foundations
situated on 63 Vernon St - Nancy Young 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 THE'M S
'< Certificate of Occupancy
Building Inspector
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. g Cit y of Northampton PX Q UWXD INSPECTIONS
BUILDING DEPARTMENT
1.
. Sa ccttugral and Walls
Components in Place*
3. Complete Building*
No. 1151 Office of the Building Inspector
Zoning Form No. 963083 Date 12/10/97 Fee $64.00 Check# 1233
Page, 31A Parcel 97 ,Zone_11F�ZBWP Section 127 ❑ Yes ® No
BUI]LDING PER Mi' IT
*Plumbing and Electrical Inspections required
THIS CERTIFIES THAT James Phaneuf before Building Inspections
raise section of rootiadd door to decic,71h ew entry
has permission to & (2) new windows Inspection an Site—Foundations
situated on 63 Vernon St - Nancy Young Inspection of Plumbing—Rough
provided that the person accepting this pert shall in every respect Inspection of Plumbing—Famish
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 n the City of Northampton. L
Any violation of any of the terms above noted is an immediate revocation spection of Wiring—Finish
of this permit.Expires six months from date of nuance,if not started. U4��/9 �uildin Inspection—Rough o�C a• 3-9�
Building gh - �
Note:A certificate of occupancy will be issued by this office upon return 'O Insulation Inspection
of this card signed by the Plumbing,Wiring and Building Inspectors.
Building Inspection—Finish O k
Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLA D IN A CONSPICUOUS PLACE ON THE S
Certificate of Occupancy
Building Inspector