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�1 Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. ��� /�,�' Alterations
NORTHAMPTON, MAS 19� Additions
APPLICATION FO PE�MIT TO ALTER Repair
Garage
1. Location M, Lot No.
Ily 2. Owner's name Address
3. Builder's name Address t . e d
r
Mass.Construction Supervisor's License No.^��S c��,�'io 9� 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
13. Siding house
14. Estimated cost:- t� r
The undersigned certifies that the abov statements are true to the best of his, her
knowledge and belief.
G
Signature of responsible app,icanl
G s
Remarks -� � � - �
e e M
assxt yn:rlta
0
m DEPARTMENT OF BUILDING INSPECTIONS'
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WOMCER'S COMPEN UON XNSURANCE AFrMAVFr
7
(li�nsc^Jpernv tic:.)
%vith a principal place of businesslre idence
(phone;t) „s
— (str�t/cit}/sic/np) L%O,S/
do hereby certify, under the pains and penalties of perjury, char:
O I am an employer providing the following \vor',er's compensation coverage for my
employees worming on this job.
(,Mu cc Comp2my) (Policy Number) (Expi mtion Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contraztors listed below who have the following worker's compensation policies:
(Name of Contractor) a Qmsu=�Company/Poky Number) (Expiration Date)
(Name of Contractor) (Insurance CoapanyiTodcy Number) (Ex-pimdon Date)
(Name of Contractor) Qnsuran(-- Compan),/Poticy Nuub�r) (Expiration Date)
(Name of Contractor) (LnSW-MC-- Compauy/Poky Number) (Expiradon Date)
(ems a6d?600md sbczt if nooca,.ry to incltuk infixm 0.pain Wing to arl oodrnc ors)
I am a sole proprietor and have no one woridng for me.
( ) I am a home owner performing all the work myself.
NOTE:plcasc be awarc Ilut whi]o homcowncra wbo cmplay person:to do�;*,+,,, n c oom.nuzioa-or rcpa.r wnrk on i d-Axi ing of
not mote tban ibrco uarts ra wbich the bomoov n raidca or on the goundr appuzicawi ibercto err not gmcrally ooaridcrcd to be
cmployrrs under tba wocka`s ocmpam4ca Act(G L152,=1(5)�aWLiczdoo by a bomcownrr far a 60=c cc permit may cvidcnoc tho
legal etaau or an employer under tho Worirela compconatioa ArL
I understand that x copy ofthin mtemcut onay bo forwarded to the Depertm ai ofInditrriel Accideoii of5oe of inmAr-oco for the
eovcrage vcrifiesiioo and that fade c to coact=covambo under sowoa 25A of MOL 132 m Iced to tbd impo�-of erimiail pcnaldea
oomiszias o£a.fine of up to S l,5oo.00 mxvcc imprisoamcst of up to ooe year and cava p�ltia is the foem of a Stop Work Orda and a
firm oCSlt)D.00 allay agAiaA tat. .
JJ
Signed _day of 1997 Fo<d —ooly
Permit Number
Map;J I.,ot 11
Signa of Liocnscc/Pcrrnitt=
t
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 cclw= to be filled in
by the Banding Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
' &paved parking)
# pf -Parking Spaces
f fof Loading Docks
Fill:
4 vol-lime--& location)
13 . Certification: I hereby certify that the information containpj herein
is true and accurate to the best of my kno ed
_1
7 APPLICAivT's SIGN
ATU
?" NOTE: Issue o® of z in
g permit does not relieve an—a6 plioanYs burden to comply wltfa,.atl-
zoning irements and obtain all required permits from the Board of Health, Conaeiwtation
iCommisslon, Department of Publio Works and other applioable permit granting authorities.
FILE #
r
r,
7 i a 199
File No. [?c9l(b(01 l
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: ��/t-! Telephone: L.� � -��r Z i
2. Owner of Property:
Address: /� r d- 4 Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain),
4. Job Location: 17�T
Parcel Id: Zoning Map#_ /�� Parcel#X_ District(s):,_XZI.A
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
S. Existing Use of Structure/Property Jr ,
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
ZZZ
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:
P (FORM CONTINUES ON OTHER SIDE)
r FILE I
AUG 1 81997
7
APPLICANT/CONTACT PERSON: .GL &616
Y. AD RESS/PHONE•
PROPERTY LOCATION: J dz% (. a--&4,
MAP___Z"7C> PARCEL: YZ ZONE Z
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
IORM FIT IT ()TTT
Fee Paid
]Ridldin2 Permit Ulf-- 011t
— _
J
Arreggnry Ctr»rtnrP
Rnildinv Plan-, Tndiided-
0 suer/Orrupant Staternent or License ii
THELOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
t 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 Conservatio ommissio
a Signature of Buil g r Date
NOTE:Issuance of a zoning permit does not relieve an applicant's burden to comply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
ww
.9. City of Northampton REQUIRED INSPECTIONS
BUILDING DEPARTMENT 1. Footings and Walls
�► 2. Structural Components in Place*
3. Complete Building*
No. 783 Office of the Building Inspector
Zoning Form No. 962666 Date 8/20/97 Fee $20.00 Check# 5828
Page, 17C Parcel 87 ,Zone URB Section 127 ❑ Yes ® No
BUI]LDING PERTVHT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Bob Thibodo before Building Inspections
has permission to strip & install ply,reshingle,l ply rubber porch ext Inspection on Site—Foundations
situated on 100 Chestnut St - Sharon Rupp Inspection of Plumbing—Rough
provided that the person accepting this pemiit 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 r1p O MISES
. Certificate of Occupancy
Building Inspector