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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
r Garage
1. Location Lot No.
2. Owner's name 44- 1'Z KC-1 Address
3. Builder's name Tc WX (L ;-) lc ll Address _
Mass.Construction Supervisor's License No. Expiration Date y
4. Addition
5. Alteration r�� y
6. New Porch NAC,l tics >oc/° f r°: C` L' l In
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
% 17 The undersigned certifies that a above statements are we to the best of his, her
know)c4g and belief. 1
JJJC Signawre of respo iRe app icant
Remarks
_ C
V SEP s 2 91991 ' Crx i 'W.art4allt�yf1211
DEPT °`� aesxchusrtfa
vt t
m ` RIB�1L' _1 EP RTMENT OF BUILDING INSPECTIONS
2 Main Street + Municipal Building '
Northampton, Mass. 01060 '
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
�� L,
(licenserJpermitt>re}
with a principal place of business/residence at:
l (phoney#) r �
(stre`t/ci ty/staieha p)
do hereby certify, under the pains and penalties of perjury, that:
O I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(insurauce 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 Comparly/Policy Number) (Expirafta Date)
(Name of Contractor) (Insurance Company/PoLcy Number) (Expiration Date)
(Name of Contractor) (Insurance Compare}•/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional shcet ifne,ceasary to mcWc information prstaining to all ooadrn r3)
( 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 tbat wbilo homcowncta who crnplay perzom to do maimmr:c coustruaion or mpair work on a dwelling of
not more thaw throe units in whicfi the bomeowncr sides or oo the grounds appurtenant thereto arc not generally ooaridered to be
employers under tbo wmic,a' compcas4on Act(GL152,m l(5)�application by a homeowner fora Gnaw or permit may cvidcnoe the
legs!ctatua of an employer under the Workers Compemation AcL
I understand that a copy of this date may be forwarded to tho Dgmrwxmt of Industrial Acci&a&Offioo of Inwcwoa for the
coverage vuificatioa and tbat failure to&enure coverago under soctioa 25A of MGL 152 can lead to tba imposition of criminal penalties
oomistiwg of a fmc o!UP to S1,500.00 andlOf of up to one y=and civil penalties in the form of r.Stop Work Order and a
find of 5100.00 a day against:me.
Signed this of 1997 Foc dqmtw=W uao only
Permit Number
Map;rf Lot;ef
Sig mblre of Li ermit tec
r
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 cols to be filled in
by the Building Department
Required
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)
_pf. -Parking Spaces
# rbf Loading Docks
Fill:
'4vo1-time--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: (—' c f� % APPLICANT's SIGNATURES
r" NOTE: Issubnoe of a zonin permit does not relieve an a
9 p pplioanra burden to mp, wltlf,. 4l::
zoning requirements and obtain all required permits from the Board of Health, Conreervatlon
Commission. Department of Publio Works and other applioable permit granting authorities:;:.
�� FILE ,
m'U L
;� �► 2 9199�i `��
DE NORTNAhSI°ya�IMA O1G6QtdS
Fi 1 e No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
Name of Applicant: r� 8,
Address: 5 /'C x -��, Telephone:
(2) Owner of Property: /C)/I1
Address: a CX)"1'.7 �� � 0C. ki`- elephone:
3. Status of Applicant: _Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: I 1� /.
Parcel Id: Zoning Map#� c�?C Parcel#_ District(s): .
(T BE E FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/VVork/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/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 X' 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 9G 22836
_ a�
#
SCP 2 91997
�Tp T CT PERSON:
DE � A
w N _ r
PROPERTY LOCATION: ` -
PARCEL: 9V ZONE A
THIS SECTION FOR.-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Fee Pnid
U
Type of Constniction-
THE,FOLLOWING 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 4*1val-Bd of Health Well Water Potability-Bd Health
,!Permit from Consery n CopmUnion
66 9
Signature of Buildin ector Date
NOTE:Issuance of a zoning permit does not relieve an applioant's burden to oompty 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 authorities.
a g City of Northampton REQUIRED INSPECTIONS
. Footings and DEPARTMENT 2 Structural Components in Place*
3. Complete Building*
No. 932 Office of the Building Inspector
Zoning Fonn No. 962836 Date 9/30/97 Fee $20.00 Check# 1724
Page, 12C Parcel 91 Zone URA/WSP Section 127 ❑ Yes No
BUn-JDINGPERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Tom Quinlan before Building Inspections
has permission to shingle roof over 1 layer Inspection on Site—Foundations
situated on 5 Rick Drive - Kenneth Misterka 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
Smoke Detectors(Fire Department)
and woodstoves
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOU MISES
Certificate of Occupancy