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17A-076 (2) • a > o rn �. m c\j 3 O to cv r ..t Z m co Z CD Z I � _ Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No, � Alterations NORTHAMPTON, MASS. �U 197 Additions a APPLICATION FOR PERMIT TO ALTER Repair Garage 1. Location IT �/d Uc�'�/�/L� �v /�►"�h"� Lot No. 2. Owner's name � Address 3. Builder's name �L Address L/S' SCI i� 4r Q-� Expiration Mass.Construction Superv' is License No. Date 4. Addition ,,gM 5. Alteration 6�D► 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-�6V©Od The undersigned certifies that the above statements are we to the best of his, her knowledge and belief. Signature of responsible appicant Remarks v '" 1 OCT 2 21997 rod /2000.,-Vz .61all zl-lob�" MW 11191a 4z MATI-111�,6 jj",V;r 6,011 /9'dou'P, 1-A'-;11.je 6 14,11 tl 7a IVIO L l I Wit C4�/'a o "PA) T11 F- I q -6 019WAI —'F010f06 T#9&e NA17d&n,079A1 Q Valley Home Improvement, Inc. 1997 Not in bn duplicated or used for any purpose without writton permission of Valley Home Improvement,Inc. 320 Riverside Dr.P.O.Box 60627 Northampton,MA 01060 To]:413-584-7= Fax 413-585-= O�{ttAMP�O OCT 2 21997 CrifLI of 'dartilamptvn = B 6 �lasaarhnactia m DEPARTMENT OF BUILDDIG INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 ' WORKER'S COMPENSATION INSURANCE AFFIDAVIT Nelson A. Shifflett / valley Horne Improvement, Inc. (Ecensee/permittee) with a principal place of business/residence at: 320 Riverside Drive Northampton, MA 01.060 (phone#) (413) 584-7522 (strer..t/ci ty/stat d2j p) do hereby certify, under the pains and penalties of pedury, that: M I am an employer providing the following workers compensation coverage for my employees working on this job: Eastern Casualty Ins. Co. WC9660047 2/1/98 (Insurance Company) (Policy Number) (F_xpirat on Daze) ( ) 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 Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (arias,additional sheet if neorsury to include information pataiaing to all ooabma rs) ( ) 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 that while homcowoem who employ pasom to do maiaimaneq carsuctioa or repair work on a dwelling of not morn than throe units in which the homeowner resides or on the grounds appurtenant thereto are not gaw lly woude ed to be employers under the worker's oornpe nation Act(GL152�s 1(5)),application by a homeowner for a limn or permit may evidenoe the legal status of an employer under the Workeek Compemation Act I understand that a copy of this d ernent may be forwarded to tho Depwtmma of Indudrial A=dw&Oboe of Imrusnoe for the coverage verification and that failure to&oases coverage under section 23A of MOL 152 can lead to the imposition of criminal penalties oomisting of a fine of up to S 1,500.00 and/or imprison of up to one year and civil pemities in the form of a stop work Order and a find of SIoo.00 a day against tae. Signed this _day of 199 For dcpmtavnw uao only Permit Number Map# Lot# Signadir•e of Li ernuitce 10. Do any signs ebst on the property? YES NO__Jf�' 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 co-2 to be filled is by the Ru lei;..g I?apartm nt Required . Existing Proposed By Zoning Lot size NO Frontage IV Setbacks y pPA - side L: f R 0 - rear Building height Bldg Square footage %Open Space: (Lot area m1nus bldg &paved parking) Qf marking spaces _i%f Loading Docks Fill: =(voXdme-& location) "13 . Certification: I hereby' certify that the information contained herein _ is true and accurate to the best of my knowledge. D72E: jo= _. ) APPLICANT's SIGNATURE NOTE: [ssuanoe of as zoning permit does not relieve an appli nt's burden to comply with all coning requirements and obtain all required permits from th Board of kiealth, Conservation Commission, Department of Public Works and other applioabia permit granting authorities. �;! FILE # OCT 2 21997 File No. 9 ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: ��X��r� �:,1 Cl r c Ly�zve 4l� Address: Telephone: 2. Owner of Property: 0 l__l/ Address: �r�� Telephone: �sm - 1-j 5 3. Status of Applicant: Owner Contract Purchaser Lessee X Other(explain): �C- "I)i,,&4,4 t-'- � 4. Job Location: Parcel Id: Zoning Map# 1-74 Parcel# District(s): � (TO BE FILLED IN BY THE BUILDING DEPARTMENT) S. Existing Use of Structure/Property /N 1- 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) P'ermitNadance/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 # 9 6 2 2 9 OCT r APPLICANT/CONTACT PERSON: ADDRESS/PHOA: D E> - PROPERTY LOCATION: C�-e 6 Z�✓ Q-�� _ ./ MAP 7 PARCEL: ZONE THIS SECTION FOR-OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM EELLED OUT Fee Pnid -Rerandelin2 Interior T] �LLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION: �l//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 I/ 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 Conservat' Commissi n '17//C,� Signature of Bull * gkpreclor Date NOTE: Issuanoe of a zoning permit does not relieve en appiioant's burden to oompty with ail zoning requirements and obtain all required permits from the Board of Health, Conservation Comminelon, Department of Publio Works and other applioable permit granting authorltles. City of Northampton REQUIRED INSPECTIONS �► ` e 1. Footings and Walls BUILDING DEPARTMENT 2. Structural Components in Place* 3. Complete Building* Office of the Building Inspector No. 1019 Zoning Form No. 962929 Date 10/27/97 Fee$40.00 Check#8298 Page, 17A parcel 76 ,Zone URA/WSP Section 127 ❑ Yes No BUI]LDINGPERMII * Plumbing and Electrical Inspections required THIS CERTIFIES THAT valley Home Improvement Inc before Building Inspections has permission to remodel bathroom Inspection on Site—Foundations situated on 8 Cloverdale St - Tracy Wharton 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 Smoke Detectors(Fire Department) Other THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON REMISES Certificate of Occupancy wilding Inspector