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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 5 OD J �� y Alterations
NORTHAMPTON, MASS. 016 \(O I qaj Additions
APPLICATION FOR PERMIT TO ALTER a Repair
Garage
1. Location 6e Lot No.
2. Owner's name to A-,( t:-c-\1t, Address
3. Builder's name P ,`O �-vy Address
l �� ` \O t Mass.Construction Supervio 's License No Expiration Date
4. Addition
5. Alteration (�`��'\ l� t'��C :uci • -l (\S n
6. New Porch
7. Is existing building to be demolished?
S. 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
�a
14. Estimated cost- a�'
The undersigned certifies that the above statements are true to the best of his, her
knowle a and belief.
Signature of responsible app,icant
Remarks Ctt ' .��✓,., �v4- ,1 v� L3\ fie, (�C7 ,<C. ,/.?5 �1 �I�C
U, Y-,LA
1997
r �la�aarhasrtts
m - DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, �4N
ccnseelpermittec)
with a principal place of business/residence at:
S<< o-, 'y1A (phone#) Gal - C-110
(strret/ ty/stalrhip)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees worming on this job:
(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:
� a
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance ComparlyiPoticy Number) (Expiration Date)
f
(Name of Contractor) (Insuranc Comp;ul)•,Policy Number) (Expiration Date)
i
(Name of Contractor) (Insurance- Company/Policy Number) (Expiration Date)
(attach additional short f ncccxsary to include infornutioa pertaining to all oocitra ton)
I
I am a sole proprietor and have no one working for me. C%4^t Q Prl
( ) I am a home owner performing all the work-myself.
r
NOTE:plcaae be aware that while bomcowncn who cttsploy pa-,.ont to do mai,,fm,nec construction or repair work on a dwelling of
ant more thsn throe units in%v"'c:h the homeowner mides or on the£7ouo appurtenant tbac o arc Dot gtocrally ooaridcrod to be
cmploycn under the wocka"0—Paasation Art(GL152 v 1(5))�application by a homeowner for a Ganx or permit may cvidcnoe the
legal ctahrr of an employer under tho Worker's corupeo atiou Ad.
I understand that a oopy of this etatcmcat shay be fbcww ded to the Dcpartaxnf of, duti aj Accid l7ffioo of Inwtwoe for the
coverage vqTicatioa and that fiiltuc t4 acarre covcrttbo trrrdct scctioa 25A of MOL 152 can Icad to the impo oa of criminal peaaltia
000tiuing of a fine of up to S 1,500.00-Wor of up to one)tar and avi�ponities in the form of a Stop Work Order and a
fins orS104.00 a day LpinA me.
Signe this �__day of (2)C..k 1997 FCC dcp=t=tn ltueOnly
Permit Number
Map# Lot#
Si of Lic=--.v Pctmittce
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 Dkpartment
(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
# (of Loading Docks
Fill:
-(volume -& location)
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my kn wledge.
DATE: GC�'- (� 1�( APPLICANT's SIGNATURE -
NOTE: luauanoe of a zoning permit does not relieve a plioant's burden to oomply With all
zoning requirements and obtain all required permits m the Board of Health, Conservation
Commission, Department of Publio Works and other a plionble permit granting authorities.
FILE #
OCT I h 1997
File No.
19 0?
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: l-V% k'
Address:-'�-N ' A \A Av--t61 a Telephone: '-113 :S
2. Owner of Property:Adv(q
Address: Telephone:
3. Status of Applicant: Owner <\ Contract Purchaser Lessee
Other(explain): (1
4. Job Location:
Parcel Id: Zoning Map#-j-i�_ Parcel# District(s): .,6Z4,a-
(TO BE FILLED IN BY THE BUI DING DEPARTMENT)
S. Existing Use of Structure/Property 4a\'A'4r-'
6. Description of Proposed Use/Work/Proj ct/Occupation: (Use additional sheets if necessary):
V4 V
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 an /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 # 962911
APPLICANTICONT`ACT PERSON: ', '�462
ADDRESS/PHONE: ' _
PROPERTY LOCATION: /Crti
MAP PARCEL: ZONE_ /f„
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FH,Y,FD ()TTT
Fee pflid
Biii1ding, Permit Filled njit
Remndelin2 Interior
Addition to Existing
:./
t/
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T ApOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
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 omission
O /
Signature o ui Or
Date
NOTE:Issuanoa of a zoning permit does not relieve an applioant's burden to oompty 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 authoritles.
City of Northampton REQUIRED INSPECTIONS
.
BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
No. 996 Office of the Building Inspector
Zoning Form No. 962911 Date 10/17/97 Fee $20.00 Check# 2544
Page, 17A parcel 104 ,Zone URA Section 127 ❑ Yes 0 No
BUI]LDINGPERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Pepin Roofing before Building Inspections
has permission to reroof porch over 1 layer Inspection on Site—Foundations
situated on 310 Bridge Road - Harriet Shaw 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 PLACE ON T REMISES
Certificate of Occupancy
Building Inspector