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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
1 NORTHAMPTON, MASS. AU!� 19 7
Additions
Repair
' APPLICATION FOR PERMIT TO ALTER
�� Garage
1. Location 6 7 /`I/��Cb�5, lA6/U� Lot No.
2. Owner's name DOV e— 2062229-1J Address /12 a-ae5T bdt
3. Builder's name LD /nd/, 677' \ (2 Address 41 - S/
Mass.Construction Supervisor's License No. Expiration Date
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 1,Q
Odd` S /� �°�✓ f} h,4�7 S �N S
13. Siding house
14. Estimated cost:- 9G�S
The undersigned certifies that the above statements are true to the best of his. her
knowled and belie
Signature of responsible appucan!
Remarks
r«
�-CtiNfP�.
B6 Mx3%cchrc'scIto
m DEPARTMENT OP BUILDDIC INSPECTIONS
212 Main Street ' Municipal Building 'o
Northampton, Macs. 01060
t� WORICER'S CONMENSATION INSURA-NCE Al'=AVIT
(h�nsr.Jp✓ruv ttce)
with a principal plaoc of business/re-sideoce at: /
�-t oz;" s/� �I ^� //I///� (phoncff)
(str�t/ci t�/stald�p)
do hereby cerL1Jy, under the pens and penalties of dl:is
( ) I am as1 employer providing the following rror',_er's compensation covc:-21C for my
employees worming on tdiis job:
(Insurance Cornpaay) (Policy Number) (Expiration DatE)
( ) I am a sole proprietor, general courractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contracwr) Qnstuanc-- Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiraaoa Due)
(N2-me of Conllaclor) (Inswranc:� Compaily/Pobcy Numb'Lr) (Expiradoo Dale)
(Name of Contractor) (Insu=ce�Compaay/Policy Number) (E)Tiration Dates)
additional d}� irnoo--a y to cxtidc inrocmaaoo pazimn6 to.11 oodi-..inn)
(/am a sole proprietor and have no one worming for me.
( ) I am a.home owner perfor-i=g all the work myself.
NOTE_please be awzre that whilo bomccrwo wtio c=ploy per;o=w do "•t,,,�coaxruetion'or rcp'.ir work on a d.ti-ll of
not most tb=n tbroo units is which the bomoowncr rc%!dcs cc oa the goefads appurtcasaitba<fo ere oot gco.vily coaridctcd to be
cmploycn under tbo wock=Ax oompcn 4ca Act(G L152,sa 1(5)1 APPlication by a bomoowocr for a lictax or P==:d may cvidcox the
legal rt+h,•o£an employee uodertho Wocfrola coov..atioa Act'
I uadtrstaad that x oopy of thin�famcat may be forwro m6d to the Dopnrmxat of Lodut d ik,6dz=&OfSoo of lawn oo for the
c ovarage vcrificatioa and that failtuc to toaut:coverago under zocdoa 25A of MGL 152 can local to tbd impoSi6oa of aiminA peaeltic
ooqustmg or a fine bf u p to s 1,5oo.0o twor impraoamcnj orup to om year and civil p=LIUCS in the focm of a Stop W or1;Ocdcr nod a
5fm oCSL00.0o a day agaiaA mc. .
' Signed this `7 d.ay of G 199 7 F0rd��U-- 'Iy
Permit?Iumbrs
1.,api Lot i!
Signaarm of L,iccnSCCfPCrmittcc
s� "
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 —?== to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - front
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lotarea menus bldg
&paved parking%
# .of Parking spaces
f %f Loading Docks
Fill:
4 volume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
_1
DATE: G APPLICANT's SIGNATURE ��..
NOTE: issuance of a zoning permit does not relieve an a lioant'a burden to oom P.ly wit
9 P PP 111,.+P11
zoning requirements and obtain all required permits from the Board of Health, Coinservtstion
Commission, Department of Publio Works and other applioabla permit granting authorities.
FILE #
P.
AUG 41997
File No. 4"4� / t
ZONING PERMIT APPLICATION (§10 . 2
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: tad I 5e 77-
Address: /mil ,Sj- Telephone:
2. Owner of Property: D>1}Je 7\O e!22A�--
Address: (,A 7 /—�( 1'�C�eST �� _Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain)::
4. Job Location:
Parcel Id: Zoning Map# Parcel#_ District(s):, &�
(TOD IN BY THE BUILDING DEPARTMENT)
S. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
lyeev
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 # 9 5 6 2 1 / r
At1G 41997
APPLICANT/CONTACT PERSON: 8 "��7
ADDRESS/PHONE:
PROPERTY LOC TION:
MAP Z PARCEL: 6 9 ZO
THIS SECTION FOR-OFFICIAL USE ONLY:
PERK UT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM M,T,FD OITT
Biiilding Permit Filled nut
< -
Fee Paid
New Cnnqtrnrflnn- --
Remodeling Tnterinr
Building Pinny Included.
� � f
THEY61,LOWING ACTION HAS BEEN TAKEN ON THIS AP ICATIW
_JZApproved 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
Per 't from onsQFv C on
/ ..;
Signature of Building hwOctor Date
NOTE: Issuanoe of is zoning permit does not relieve an applicant's burden to oomply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other npplioeble permit granting authorities.
City of Northampton REQUIRED INSPECTIONS
1. Footings and Walls
BUILDING DEPARTMENT
2. Structural Components in Place*
3. Complete Building*
Office of the Building Inspector
No. 732
Date 8/5/97 Fee $20.00 Check# 2295
Zoning Form No. 962621
Page, 17A Parcel 307 ,Zone LIRA Section 127 ❑ Yes 0 No
BUI]LDINGPERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Ed Corbett Jr before Building Inspections
has permission to strip & reshingle roof Inspection on Site—Foundations
situated on 67 Hillcrest Dr - Dave Jorczak 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
m
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 CONSPICUOUS P CE ON T P ISES
w Certificate of Occupancy
Building Inspector