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/ Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. (� � Alterations
NORTHAMPTON, MASS. 1 q Additions
a -APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location �� 711 . ?�'� �L � Lot No.
2. Owners name )/ il d( ill'La �'7 Address -37 1t`C'iL� 1
3. Builder's name --Kv ,f Address f k Y S 144,(1e, /&')A
Mass.Construction Supervisor's License No. 001 ,601 Expiration Date
4. Addition
5. Alteration -7Z-,g.�ts!/
6. Ww Porch ! !I I- V 1t4� S��'t4€ 1 icC�r� ��—�cy 6j1 �� 5�4 �1� L�-',� .���:_� te, • J Jct�erL(
7. Is existing building to be demolished? N D I"
8. Repair after the fire 0i)
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.
�W 6)0-e�
Signature of responsible app,icant
Remarks W'ti-+ut t, ,a tit, 4mw ye te. .;�, �. ��� ,_ t,6A.
ti
8
V,, 1"AR 5 11998 �lasaacanactta
DEPARTMENT OF BUILDrNG INSPECTIONS ^
t ' 211 Main Street ' Municipal Building '
a�
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
with a principal place of business/residence at:
(street/ ' stalrhip)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the followii-g worker's compensation coverage for my
employees working on this job:
(amirance 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) (Insurance Compauy/PoLicy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach=kHocal:beet ifnooeaary to include infvcmihon perwiaing to all mau=tors)
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 avrAM tbat while homeowncra who employ perzons to do coadnrction or repair work on a dwelling of
not-%*then throe units in which the hoaoowncr resides or on the voun ds appurtenant tbecdo arc not generally considered to be
employers under the ware's comQezu 4ca Art(GL152,ss 1(5)),application by a homeowner for a lieease or permit may evidence the
legal&talus of an employer under the Workeet Compeosdion AcL
I understand that a oopy of this scat--t may be forwarded to tho Depacroscn,of ln&L rid Aoadw&Olfioo of Insurance for the
oovrrage vaifiauioo and that failure to seams cavengo under socUoct 25A of MGL 152 an lead to tbo imposition of—m-1 penalties
oomisiing of a-fine of up to S 1,500.00 andlor of up to one year and civil penalties in the form of a Stop Worst Order and a
find of 5100.00 a day against rat-
For dial uic only
Number
`j �3-� Lot#
S1 iatur�aL,0�er miux
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.
Thin col== to be filled in
by the Building Depamtment
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
# of Loading Docks
Fill:
4 volume--& location)
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
.1
?(DAI'E: *PLICANT's SIGNATURE
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply With all
Czoning requirements and obtain all required permits from the Board of Health. Conservtation
ommission. Department of Public Works and other applicable permit granting authorities.
FILE #
'
5 ►998 y
a I File No. 32-7 <-;2,
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR P T ALL INFORMATION
1. Name of Applicant: Pf4 > >�
Address:_ Me G-L Cc2"s-r X7/2 Telephone: L111
2. Owner of Property: SEEMED S. 0 1 1-Q �M j T IZ
Address: ! 7 8/L1_C12E0 1PRiLI Telephone/�s�� ;� tl)
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): /
4. Job Location: / 7 L4 C
Parcel Id: Zoning Map# Parcel# 4M District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5, Existing Use of Structure/Property e,5 iUelflo
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
/,V I e1-?1 oT_ e /
�LAO r AST-e✓a- I S t &I �, 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 KNO!A/ 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__k_ 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)
9631- 72
FILE #
MAR 'D 1998 1
APPLICANT/CONT jCT PERSON:
ADDRESS/PHONE: %'�
PROPERTY LOCATION:
MAP PARCEL: ZONE,,",20 ..
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FH,T,F,-D OUT
Fee Paid
Ruilflin2 Permit Eilled nut
-Fee pnifi d/1_5_1/ f6 _ ✓.
Additinn to Existing
ArressoryStrurture
0,�nerinrrupnnt Statement njj���, le),-)lm
THE LOWING ACTION HAS BEEN TAKEN ON THIS APFUCATIOM
Approved as presentedfbased 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
!*t from Conservation mission
Signature of Building Wector bate
NOTE:lnsuanoe of n zoning permit does not relieve an appiioant's burden to oomply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commisslon, Department of Publio Works and other appiioable permit granting authoritles.
City of Northampton REQUIRED INSPECTIONS
i► 1. Footings and Walls
BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
No. 1336 Office of the Building Inspector
Zoning Form No. 963272 Date 3/6/98 Fee$40.00 Check# 2654
Page, 17A Parcel 299 ,Zone URA Section 127 ❑ Yes ❑ No
BUI]LDING PERM11
*Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Thomas W( 3t before Building Inspections
has permission to winterize porch Inspection on Site—Foundations
situated on 157 Hillcrest Dr - Brevard Williams Jr 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 PREMISES
Certificate of.Occupancy
Building Ins or
a