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17C-092 (11) a T � m a el T Z m a- f!7 O U Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. �a 7' ?� '�3/ Alterations NORTHAMPTON, MASS. -19 Additions ' Repair ' APPLICATION FOR PERMIT TO ALTER Garage 1. Location / . rrr�'cr' r5'i /�cr�,OF.Y Lot No. 2. Owner's name 1ffo1y46w/ Address /ZZ- &Irc 3. Builder's name AP l ice✓✓ �� _Address .3(eGt icdaz� S'j- �f1J .-r�e°'�✓ Mass.Construction Supervisor's License No. C1.:5 22_5 Expiration Date dz'ow 4. Addition 1.�ECA, 13 a6c cz/r;5" a ,-l( e ie 5. Alteration 6. New Porch )14 7. Is existing building to be demolished? A/0 8. Repair after the fire 9. Garage No.of cars Size 10. Method of heating iV-Ao E 11. Distance to lot lines ra srwr. 12. Type of roof �I <ew_ 13. Siding house 600V9 - 14. Estimated cost- �K i The undersigned certifies that the abov, ements are true to the best of his, her knowledge and belief. Signature of res ible app ican! Remarks Co)TR L (-)r I(v i�5_�c,K 6) 7t (a '-X r �u f' <3 6rf-a,:�- �ZAVe- dawn. / c1r2 cwt �f-e �k� c5a!'/f�✓� �si3 �t�fJ �Co ` CEl'�� /C.t�-rUh.��S /�✓.'� �T/9-.i2.S '�`-�! 'xb " C.-�O,rcT-�^ 0 q`.�tv�MA`7^'� - B � E 1998 lassxrF♦nsftia Fp7 DEPARTMENT OF BUILDrNG INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT (ll censerJperml tt ee) with a principal place of business/residence at: CE lzpsi 5T tike s- ao✓ty /Vi'f (Phone0 5_�2-3-Qd (str�t/city/stalr.Ja P) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following woi-kcr's compensation coverage for my employees working on this job: (lasurance Company) (Policy Number) (Expiration Daze) 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) (lnsuranc-, Company/Policy Number) on ate) (Name of Contractor) (Iasuranc: Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance, Comparty/Pokcy Number) (Expiration Date) (Name of Contractor) Gmsu ance Compauy/Policy Number) (Expiration Date) (attadi-k tioml shod ifncocis,ry to ffKj,.I&informifioo pertaining to all zaclnrs) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware thst wbilo homeowners who employ pca<ow w do rt rrrtmxacc constuctioc or repair work on a dwclliag of not moo thaw thcoo units in which the ho=owncr midcs of oo the grounds appttrtenaat tba do ate cot generally 000si kmd to be employers under the wmkces mmpcusation Ad(GL152,"1(5))•awlication by a homeowner for a licm3c cc Panla may cvidcnoc tho legal etsdiit of an omployef under thn Worko es comps.:,o Act I ur kntsnd that a copy of thu craicmmt may bo forwnrded to tho Dcpnrtmcof of Ind<ufrial Aside'Oiboo of las noo for ttm covemge verificatioa and that failize to aocure eoverago under soetioa 25A of MOL 152 can lead to tbo imposition of criminal penalties oof a.&ne'of up to 51,500.00 and/or irapris t of up to one year and civil pczm1 i a in the form of a Stop W mk Ocda and a find of 5100.0 a day igainsi tic For dcgutm�—� Permit Number M 0 _Lot# Si of Li ttcc Z- 2 x 10 p.r g6nm z _ O b 2 2"x101' P•T gLegyv� Ap �X►5-n N kloUS�, � 6 Z2. CPrF-n5rr,W- -ST. ROKFNCE 1; �" Pa�¢r� co�p� so�ztxirgs 2• '�Iy�� r �� CE��. D�CK1n�C�- M o iz i mzry t27. G+.5,n c J'J or iA �o i I N 1 I 50 x . o t 1 v�W C H E57N ur 677, 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_Z. IF YES,describe size,type and location: 11. ALL INFORMATION MIDST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. Thia colt= to be filled in by the Building TJvpnrtment Required Existing Proposed By Zoning (Q o x to peep/ Lot size f Sri-rr1,E f �" Frontage Setbacks ^- v 0 - side L: —/,I- R: —, L: —.21 R:_�� - rear �Ar , ---- ti Ar Building height Bldg Square footage _ =5-- l] %Open Space: part,- z av (P CX)�z r- S_ Lo(Lot area minus bldg ± x'00 Jt >'eAVE &pared pa:kingj i3 Zo 300 4-r2 i7f--CK 7 Z f#2 # of -Parking spaces # Hof Loading Docks Fill: -(volume--& location) 13 . Certification: I hereby certify that the information on ain d erein G is true and accurate to the best of my knowled e. DATE: 12- APPLICANT's SIGNATURE $�._ Z�y NOTE: las noe of a zoning permit does not relieve an oant's urden to 0o ply with ill zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Department of Publio Works and other applionble permit granting authorities. FILE # t File No. -/ 73 z(a ryrM� -m. ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: / ✓'ai �. �?rE/�/cvt/tl� Address: ST- x— Telephone: t SSA7 j 2. Owner of Property: AIAV12a6t'r✓ 141 fVAZbtt Address: `S '. ,��i✓«_Telephone: 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): Cwr7ZrkcrQL- 4. Job Location: l:;Z LtSZT1JT gT7t1`ti�� rLO«�K: - Parcel Id: Zonin g Ma P ��_ Parcel# �' District(s): (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property S1N4(-L 1EA-t-0%LN CL�Sty rd� 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): G_ P is, *(n.' c-nue .j n-t Tgwy— `E s`M&ryzw r=drr iw ��; fir ,�g�,rr r✓ +t 1r�i.�.[j ,aa rQ �atlic� Av`� 8 ®ounce cr�►.l/Lr<: xn rr� 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/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 ,4 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 '1998 L—APPLICANT/cbNTACT PERSON:— 2`2 7 -1 3 XDDRESS/PHO.NE:— 3l Z- PROPERTY LOCATION: MAP Z2_(--_ PARCEL: ZONE THIS SECTION FOR-OFFICIAL USE ONLY: PERNUT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONTNG FORM FH.T.FD OUT Fee Pnid 'Riii1ding Permit Filled nivt V iFf.� Pni(i Tylif, nf C-nngtnictinn- N,-w Cnnstriirtinn -Rernndelin2 Interinr Additinn ta Fyi-qtin2 Arressnj:V Stmchire Tnchided- Own er/OrrupantStaternent or TJF�nqe ii,' 3 Sok nf Plany /Plnf Pinn THE F LOWING ACTION HAS BEEN TAKEN ON THIS APFLICATION- pproved 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/ZON-ING 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 Signature of Bu T to NOTE:Issuance of am zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain ail required permits from the Board of Health, Conservation Commission, Department of Public), Works and other applicable permit granting authorities. City of Northampton REQUIRED INSPECTIONS A A BUILDING DEPARTMENT 1. Footings and Walls * 2. Structural Components in Place 3. Complete Building* No. 1548 Office of the Building Inspector Zoning Form No. 963473 Date 5/6/98 Fee$40.00 Check# 2213 Page, 17C Parcel 92 ,Zone URB Section 127 ❑ Yes No BUI]LDING PERMIT * Plumbing and Electrical Inspections required THIS CERTIFIES THAT, Brian Greenwood before Building Inspections has permission to construct 14' X 16' attached deck Inspection on Site—Foundations situated on 122 Chestnut St — Maureen Mayeski 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 ISES Certificate of Occupancy Building Inspector City of Northampton REQUIRED INSPECTIONS g _ A BUILDING DEPARTMENT 2. S�ctural Components in Place* 3. Complete Building* No. 1548 Office of the Building Inspector Zoning Form No. 963473 Date 5/6/98 Fee$40.00 Check# 2213 Page, 17C Parcel 92 ,Zone URB Section 127 ❑ Yes ❑ No BUI]LDINGPERMIT * Plumbing and Electrical Inspections required THIS CERTIFIES THAT Brian Greenwood before Building Inspections has permission to construct 14' X 16' attached deck Inspection on Site—Foundations situated on 122 Chestnut St - Maureen Mayeski 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 1,17ir 98 ** Install per Manufacturer's information: windows,vinyl siding,roofs Smoke Detectors(Fire Department) and woodstoves Other ` wr `t. THIS CARD MUST E DISPL D A CONSPICUOUS ISES Certificate of Occupancy Building Inspector