17C-040 (3) a > z
D a
Z m
" r p
as 7d o Z
> > 0 O
Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
�
' APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location (T�-�'� ��-- Lot No.
2. Owner's name (1 h L&U 45 77e je=-rO Le f -Address f' �� J L p L-0 N-E'_
3. Builder's name N 6 C 1-< I'()I /-,/6 t`C Address �� � /-)I,- � o
Mass.Construction Supervisor's License No. ! tl[ O 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 1
10. Method of heating
11. Distance to lot lines
y of roof
Siding house
14. Estimated
The undersigned certifies that the above statements are we to the best of his, her
know a an lief.
Signature of rerponsib/e app icant
Remarks
tt&. fps.
�tia �, Crzf� Lrf �t�xtllant}�farr _
Q � �xssnchns�llr
m D,pAR7'MENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Macs. 01060
W0RIGER'S M,(TENSATION INSURANCE AJ, , AVTr
k
vl9th a. principal place of bu_noess/residcnce at
– (sr cz:Uci t)1st2icJn p)
do hereby cerii�', u-0der the pz!ns ind p(,Daloes of perjufy, ihz-i
O I Em an employer proviLj the follo\�' )g ':or'r,er s cornoens uon cove Zoe for My
employees wor=g o❑ this job.
(Lnsurance Cony) (policy Nutnbcr) (Expiration Date)
( ) I am a sole proprietor, general coomctor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Namc of Contractor) QmsuraDc-- Compajr),/PoUcy Numb,-r) (E-cpim6ou Datc)
(Name of Contractor) (tltntr nc-- CompLE)'iPolicf Sumter) (E>-pirino❑Datc)
(Name of Contraclor) (twu=c, Compam,/policy Ntu21---t) (F-xpinaoo Datc)
(11:amc of Contractor) (tnstu-anc-- Compaay/Poticy NumtKs) (Expi-a600 Dom)
(r_a.rc?1�Cditieml r3a�d ifoce.�-zry co'c�'�d�;nrcxm»ca Fc-.�zans to to oe�--1_on)
O I am a sole proprietor aad have no ooc wor;iiog for me.
( ) I am a-home owner perforrnirlg all Lhc�lrork myself.
NOTE_please be awv m th=.t vitzilo 1occrn��-n��bo c�,oloy perzors w c5o�✓..-a:ca�-:uu�mc�=ructioncc rc,-sir work oo=Cam.<lliny or
not Mott th_n tlzroo units a wt"ch tb-t oar v des a co LS-{-ou�zpy ctRi ct kx: o uc o-C r�12y <ic a1 io be
cmploym under tba wee cr4. e�ticn let(G L152,v I(5)�apple°DO°by=6om owns far n l«nx_cc perm v S a c t5c
lc-gzl rtxr—ornn c...ployec under iho Wor cl,Cooapoaxlioa Act
I undcs-nand tb.d�.coyy of tl�m r c y b.+forw.ud�7 to tba DtP°rnxnt of .i. •-•;rl hridcoCl OfFi oa of[uvzwc for 'two
covciisc vcnBca1ioc and tb--.t riduj-c to rcci co,,�rzmd<r scc oa 25A of MOL 152 cw ku1 to Lb- pcavtics
000�ist7xLq of x Lme of up to S 1-500.00 r5eJet p ooczomt of up to cn
o�ycr•od civil paltin n be f«m of n Stop Wo> Oder and _
find 0(:s 100.00 x diy i&LiD51.mc. a
Signcd this day o 1997 F�&Pnta— —0oh
_ permit Number
Tvfapa Lot I
• _�g�atxu�of I:iccnscclF'crnffctcc
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 cola= 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;
# of Parking Spaces
# fof Loading Docks
Fill:
(vol-ume-& location)
13 . Certification: I hereby certify that the informa n contained ein
is true and curate to the best of my k o edg .
1
DATE: APPLICANT's SIGNATU
NOTE: Issu no® of a zoning
g permit does not relieve inn ap ioant's bur n / oomph► witlp,.+pll-
zoning requirements and obtain all required permits m the Board of Health. Conservtstion
Commisslon, Department of Publio Works and other applloable permit granting authorities.
FILE #
S P 51997 &69 �1 ,
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: � � 'WQ1 .A/ Telephone: ,.'5::i��<-- <5 4zSJ
2. Owner of Property:
Address: S Y Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# 1-7(' Parcel# "7-t District(s):
(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):
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
APPLICANT/CONTACT PERSON:
ADDRESS/PHONE:
PROPERTY LOCATION:
MAP_ (: PARCEL: F V 640 ZONE ,a tb°-
THIS SECTION FOR-OFFICIAL USE ONLY:
PERK HT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
7.QNTNG FORM FULED OUT
Fee Pnid
Fee Paid
Type of Constairtion-
Accessary Strurtnre
TEE LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION'
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 C mission
Signature of Building In-sp at
NOTE: Issuanoe of a zoning permit does not relieve an npplioant'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 applioable permit granting authorltles.
City of Northampton REQUIRED INSPECTIONS
BUILDING! DEPARTMENT 1. Footings and Walls
V 2. Structural Components in Place*
3. Complete Building*
No.
846 Office of the Building Inspector
Zoning Form No. 962741 Date 9/9/97 Fee $20.00 Check# 2236
Page, 17C parcel 40 ,Zone URB Section 127 ❑ Yes 0 No
BUI]LDINGPER-M-IT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Jack Miner & Son Roofing before Building Inspections
has permission to install siding Inspection on Site—Foundations
situated on 71 Sheffield Lane - Charlotte Kitowski 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
and woodstoves Smoke Detectors(Fire Department)
A,
.:;.� Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON P MISES
Certificate of Occupancy