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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
` Garage
1. Location ���� �� h�F� . Lot No.
2. Owner's name — Address
3. Builder's name i Address T
Mass.Construction Supery s License No. � � Expiration Date �aJ
4. Addition
5. Alteration e—io a n A
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 cosL-
7 C� o 6 The undersigned certifies that the above statements are true to_the best of his, her
A I � � � I ` know),edge and belief.
Ui gnaiure of res o Able ap icant
Remarks
IiAMPTO..
2 41997 Crx# iafTaz#littnt{�tn11
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE + + AVIT
I, "UJ e n(C_ a • a L` /e -
(1lcenstdpermltlee) •_----}---- .
witha principal place of business/residence at: 1- 71 C
0 no i OcJfw'�
phone#)
(street/city/statrla P)
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 working on this job:
-he.-�"r �'��1e✓S a1�(� Y53Sc� y (3 5 -8- x' 8'
(Insurance Company) (Policy Number) (Expiration Date)
( ) 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 Compauy/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(anadi additiomi shoct ifnecesury to include infa-rnatron pertaining to all oocIImcton)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE-pease be aware that whilo homernvncra who employ perlow to do maimmzncc coastruction or repair work on a dwelling of
not more than throo traits io which the boato w=resides or on tba p wods:pptutenant tbercto arc not Ccoa&Uy comidcred to be
employers under the wocictt's oomp=4oa Ad(GL152,ss 1(5)�application by a homoow=far a bcetue or permit may evidence the
legal status of as employer under tho Workeet Compeow6on Ad.
I underaund that a oopy of thu cfatcmcnt may bo forwarded to the Depvu cot of Industrial Accidw&Offroa of Imtuwoo for the
ooverxge verification and that fallme to aeaue ooverage under soction 25A of MGL 152 can lead to tbo ikon of aiminal penalties
oomisCmg of a froe of up to S1,500.00 andror kapr6onmcot of up to one year and civil pcmaltia in the foam of a Stop Work Order and a
fwa of 5100.00 a day against me.
Signed this -�Y o vhE_ 1997 For•depsrtrxtednluieonly
Permit Number IIAC'-rte QUA 16401141Jy- 1vbpY Lot 4
Signature of Li ermit
ra� Ac 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.
Thia colvmm to be filled in
by the Building 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)
# of Parking spaces
#t r6f Loading Docks
Fill:
4vol-time--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: 3 y q APPLICANT's SIGNATURE '�M%j
NOTE: luounnoe of a zoning
g permit does not relieve a p an b den to oomp itlw,,pll
zoning requirements and obtain all required permits from the 8cWrdQbf Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
JLL 2 4199
Fi 1 e 'V0. ')O L t
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: r�-� tf ( Telephone:
2. Owner of Property: Loy-
Address: Telephone:
v
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# Ili Parcel#,�_ District(s):
�
(TO BE FILLED IN BY THE BUILDING( DEPARTMENT)
5. Existing Use of Structure/Property Q '_`�� CA,n A, )
6. Description f Proposed UseMlork/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 # Cj .'l O
l
i pp77
?APWANT/CONTACT PERSON: ,- /�
ADDRESS/PHONE: c /
.w...... ...� ..
PROPERT'i' Y,OCATION:MAY PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED IREQUIRED DATE
ZONING FORM M,T.FD 01IT
Fee pnid
Fee pflid
Type, of Constniction-
Remodeling Tnterinr
ArressnmZ Structure
D
y
TH eAnLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATIW
!!/� 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
_P it fro on ry n ion
Signature of Building Wector t to
NOTE:lasuanoa of a zoning permit does not relieve an applioant'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 authorities.
Cit y Northampton TIof REQUIRED INSPECTIONS
} , BUILDING DEPARTMENT 1. Footings and Walls
2. Structural Components in Place*
3. Complete Building*
No.
711 Office of the Building Inspector
Zoning Form No. 962D9U Date 7/ 29, - reeye-v.vv Check# 2137
Page, 11C Parcel 32 ,Zone URA Section 127 ❑ Yes ® No
BUI]LDING PERTVHT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Larry Jubb before Building Inspections
has permission to install siding & replacement windows Inspection on Site—Foundations
situated on 9 Stowell St - Leeds - Dorothy Elliott 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)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS 0 ISES
Certificate of Occupancy
Building Inspector