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17C-027 (2) 3 Z m r i Cn Z Z ^• m � O 1 Zoning UlieV Miscellaneous Additions epairs; lteradons,etc. Tel.No. � T� �" Alterations NORTHAMPTON, MASS. C 7 19-U Additions ~• Repair Cki✓►mscj IAr-r APPLICATION FOR PERMIT TO ALTER p // MA Garage ` --7 1. Location �l� � "H4;1)e �� Lot No. / K� 2. Owner's name �h /�� // Address /-/i+b 17— 3. Builder's name sJ ���-f��(�iV�![i� �1��' ���+n7n��/ Address /-�-�PL- U -Uc��� Mass.Construction Supervisor's License No.-//-R 3- Expiration Date 4. Addition 5. Alteration 6. New Porch 7. Is existing building to be demolished? No 8. Repair after the fire 9. Garage / No.of cars Size 10. Method of heating >4S 11. Distance to lot lines 12. Type of roof 13. Siding house 14. Estimated cost:- /, 76cl, =37 The undersign d certjfies that the above statements are true to the best of his, her knowledge d be j Sig azure of responsible app,icanz Remarks /�f t' T%�rS /r� �/t I"7r7f✓ &0© - 6 n.TS S�47 C/..i M be- IL I n erl O¢�t1AMp�O L $ 6 �lasaactlnsctts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building S��S Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT I, �,/0/l,x (licenserJpermiuee} with a principal place of business/residence at: /L/*1` L- L3 4`UWIQI cJ (phone#) !gY7 4,j� (stzeet/city/stata2ip) do hereby certify, under the pains and penalties of perjury, that: (ty m an employer providing the following worker's compensation coverage for my employees working on this job: (Insurance 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 Comparry/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional shoo ifneocssary to imolude information pertaining to all 000trad ) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:picaae be aware dw while homcowver s who employ persom to do makicn cr,cvaswvction or repair work on a dwelliag of not awm than thine units is which the homeowacr resides or on the groin appurtenant thereto are not gataally coandered to be employaa under the wodw's compcnsstioa Act(GL152.ss 1(5)),application by a homeowner for a license or permit may-idenee the legal stab, of an employee under tha Workce%Compamatim Act I undentaad that a copy of thin datcmad maybe forwarded to tho Deputarm2 of Induatriel Ao iden&Offioe of Instuanoe for the covaage verification and that failure to seatre coverage mukr section 25A of MGL 152 can lead to the imposition of criminal peaarties coosistiag of a fine of up to S1,SOO.QO uxlloc imprisonmati of up to one year and null panitia in the form of a Stop Work Order and a fim of 5100.00 a day against sac. Si day of�� 1997 For dcp=ta=W use only r Permit Number x _ Lot# ri i ermittee .. • • Page No. of l Pages ACE CHN%INEY SWEEPS MA_LIC. #118355 115 Mlain Boulevard I LUDLOW, -HUSETTS 01056 (413) 547-$50() FAX (4A) 547-F531 PROPOSAL SUBMITTED TO PHONE DATE Philip Hall 584-4624 10-b-97 STREET 86 No. Maple Street JOB NAME Same CITY,STATE and ZIP CODE JOB LOCATION Florence, MA 01062 Same ARCHITECT DATE OF PLANS JOB PHONE John J. Ka inos 14-8-97 Same_ We hereby submit specifications and estimates for: 6 °.Homesaver GasFlex Chimney Liner: 5 footLength _u 1 Rain : 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 fiSled in by the Building Zkpartmeat 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% # of -Parking Spaces e of Loading Docks Fill: J volume--& location) 13 . Certification: I hereby certify that the in orm t 'on ontained herein G is true and accurate to the best of my kno le e DATE: lb4- MI APPLICANT's SIGNATURE NOTE: Issuanoa of a zoning permit does not relieve ftppl" OA&4burdan to oompli—m-r It4 all zoning requirements and obtain all required perm from a Board of Health, Conservtation s Commisalon, Department of Publio Work and oth s applioable permit granting authorities. FILE # File No. ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: J-l(6qP1 1kAVj� Address: 81✓6"L �U01110 4-) Telephone:—5 2. Owner of Property:—10%/1�2 Address: S-L A16 e 57— Telephone: 3. Status of Applicant: _Jz&wner Contract Purchaser Lessee Other(explain): �t / 4. Job Location: Parcel ld: Zoning Map# O K ` Parcel# X 62-7 District(s): (TO BE FILLED IN BY THE BUIL INQ DEPARTMENT) 5. Existing Use of Structure/Property 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): �l 1 rl C9 /1- n e �C� �a t I c, v� lam' �. ��l 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 KNClW t/ 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 V"�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 # q� WRIAMT/CONTACT PERSON: ADDRESS/PHONE: 7 ES-0z) PROPERTY LOCATION: ✓fit' c MAP /'7 C, PARCEL: �'I 7 ZONE THIS SECTION FOR-OFFICIAL USE ONLY: PERNUT APPLICATION CHECKLIST ENCLOSED REQUIRED DA Tinilffin2 Permit Filled nut Rprnridplin2 Interior Adffition to Existing qtrurturp C-r '7 -35---5 THE F�L,LOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION: < 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 P it from Conserva ' Com 's ' ❑ Signature of Building ector Date NOTE: lasuanoe of a zoning permit does not relieve an applioant's burden to oomply with ail zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Department of Publio Works and other applioabla permit granting authoritles. A=���• City of Northampton REQUIRED INSPECTIONS 1. Footings and Walls BUILDINGDEPARTMENT 2. Structural Components in Place* 3. Complete Building* No. 1023 Office of the Building Inspector Zoning Form No. 962937 Date 10/27/97Fee$20.00 Check#3303 Page, 17C Parcel 27 ,Zone URB Section 127 ❑ Yes ❑ No BUI]LDINGPERMIT * Plumbing and Electrical Inspections required THIS CERTIFIES THAT Ace Chimney/John Kapinos before Building Inspections has permission to line chimney Inspection on Site—Foundations situated on 86 NOrth Maple St - Philip Hall 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 CONSPICUOUS PLACE ON T P ISES < Certificate of Occupancy Building Inspector