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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. l'el 0c 19/ Additions
APPLICATION FOR PERMIT TO ALTER Repair
n 'l Garage
IOW
1. Location 3 73 /�R/ 4s, /)0 P-7X 4�'"'Q�7-0 � �'� Lot No.
2. Owners name DA 1�AJ E 4/`a-1 pe Address ?9 p dZ A, �' �•C'�"
3. Builder's name r'4� ' �'�'n1� �'��- Address'� v' '+
Mass.Construction Supervisor's Licen No. d 16 Expiration Date 01- 7'
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 tines
12. Type of roof
13. Siding house ✓° r S �:'� `� `ti /""°
14. Estimated col 3o 0"'
>J� The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
OL-
Sig ature of resportsble app icnnt
Remarks
Paz#�ttnt�r�ati
� 'g�� ,�lxaaxchnsctta
DbPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, 34-le 5-117I N a 5e' eJ 'T�i
(liaenscc/pcnnittee}
with a principal place of business/residence at:
-7J4 7G n{ Pt?�4- (phone#) sl> -yA6 7
( city/stateJ2ip)
do hereby certify, under the pains and penalties of perjury, that:
V I/am an employer providing the following worker's compensation coverage for my
employees wor=g on this job:
t�A ,P� SuA/rf✓' .v� ('(' /0')(70A 0.5,
(Insurance Company (Policy Number) (Expiration Dais)
( ) 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:
� y
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance ComaanyiPolicy Number) (Expiration Date)
E
(Name of Contractor) (Insurance Comp;tn)•iPolicy Number) (Expiration Date)
I
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach addidocul sheet if ntccnxry to iocludc infortrufioo Patai Ir to all coctC actor)
I
( ) I am a sole proprietor and have no one working for me.
( ) T am a home owner performing all the work'myself.
NOTE:plea=be aware that whilo homeowner,who employ Pcrzottt to do m___irt in a cvffiuuc6on err repair work cn a dwelling of
not race than throe unit'in ufrich the lwmoowncr residca or cc the 90-111 appurtcnaui thereto arc not grnaally ooasidacd to be
employers ttnda the twice:':oocttpcttsa on Act(GL1 application by n homcowncr for a Gan=or putnit may cvi�the
legal aRtw of an catployer under tha Wocicoea Cotnpcmation Act
I undanxad chit a copy of lhu eta coocat may bo forwn dJ to tho Dcp tmmt of lnduatrial Accideotf Offioo of 1n=Avneo for the
-o ge wrif cation aad that Ed=to scatrc covcrago tnzdct scuioa 25A of MOL 152 can Icad to tho imposition of criminal p=altiea
coosiumg of a fine of uP to S 1,500.00 and/or imprisons of up to ow)tar and d cs is the form of a Stop Work Order and a
film of 5100.00 a day against sme--
Signed this ` day of 0 C-'?I- 1997 For depatmit alttaeonty
Z � , �A,c�,� Permit Number
�� Map# Lot htrc of Liocnscclpct�utt
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 cclnffi to be filled in
by the Enilding Drpartm nt
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lotarea minus bldg
&paved parking)
# of -Parking Spaces
#' (of Loading Docks
Fill:
-(vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
DATE: I1f C��/� 9/7 APPLICANT's SIGNATURE„ 2�_j�u
NOTE: Issuance of a zoning permit does not relieve an applioant's burden to ply wit17'all
zoning requirements and obtain all required permits from the Board of Healt . Conservation
Commissions Department of Publio Works and other applioable permit gra ng authorities.
FILE #
0141991 '', Fi 1 e No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION"
1. Name of Applicant: '`
' O .�Address:.i r eG 6�
Telephone:
2. Owner of Property: f��L��€
Address:—M �OIf�+9h" ^'4Telephone: ll�7
3. Status of Applicant: Owner Contract Purchaser tZ"Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# _ Parcel# District(s):���� 1
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property `
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
V/PW 01ol y a)441-�
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.
S. Has a Special Permit/Vadance/Finding ever been issued for/on the site?
NO DON'T KN0,W 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 # 962393
OCT 1 41997
APPLICANT-AGONTACT PERSON: ' e4l
ADDRESS/PHONE:
PROPERTY LOCATION: ►,�
MAP 1-7,8 PARCEL: ZONE
THIS SECTION FOR.OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FULED OUT
Rni ding Permit Filled nilt
li>7�z
7 ✓
ete, of Plqnq /Pint Plan
T LLOWING 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 Commission
0_z/1
Sign e r Date
NOTE:Issuance a 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 applicable permit granting authoritlea.
tV�H
K, City of Northampton REQUIRED INSPECTIONS
. DEPARTMENT I. Footings and Walls BUILDING
2. Structural Components in Place*
3. Complete Building*
No. 989 Office of the Building Inspector
962893 Date 10/17/97 Fee $20.00 Check# 15748
Zoning Form No.
Page, 17B parcel 14 ,Zone URA Section 127 ❑ Yes Q No
BUI]LDINGPERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT B & R Siding Spec Inc before Building Inspections
has permission to install vinyl siding & replacement windows Inspection on Site—Foundations
situated on 379 Bridge Road - Darlene Volpe 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 woWstoves
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON tE P MISES
Certificate of Occupancy
Building Inspector