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17A-088 (3) a > 2 < n• v v o• � -ti a cD 3 O ZO m Z �..► rn A Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. �1 �.3 CU Alterations NORTHAMPTON, MASS. n(A U - 19-00 Additions APPLICa ATION FOR PERMIT TO ALTER Repair Garage 1. Location �� `� Lot No. 2. Owner's name ,Q `��i : �"`y-t t-- Address -3 K ii 3. Builder's name �� p ✓� Address - � �r+ 5 5' Mass.Construction Supervisor's License No. bF s L W1- Expiration Date 4. Addition I 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 c>,3 5 {� e �, .5{ , -e- 13. Siding house .mac- 14. Estimated cost:- The undersigned certifies that the above statements are we to the best of his, her knowledge d belief. Signature of responsible app icant 4 Remarks wt t O �O v a e Cr of 'Nort 11amp foil e of 1 61997 �lasaarhasrtte 5 DEPARTMENT OP BUILDING INSPECTIONS : '.' 212 Main Street ' Municipal Building ' ,. Northampton, Mass. 01060 WORKER'S COMPENSATTON INSURANCE AFFIDAVIT (licensecJperruittec) with a principal place of business/residence at: Ste( 1 rtS S "S `ham �L` CKA (phone#) S)-7 -3 C`( U (streetici /statel;dp) 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 fisted below who have the following worker's compensation policies: N (Name of Contractor) (Insurance Company/PoLicy Number) (Expiration Date) (Name of Contractor) (insurance Company/Tolicy Number) (Expiration Date) f (Name of Contractor) Gnsuranc; Company/T,olicy Number) (Expiration Date) r (Name of Contractor) (insurance Company/Policy Number) (Expiration Date) (attach additloow sheet if neceaary to ioclu<ic infornwioa pc-iaittg to all axrtracton) I I am a sole proprietor and have no one worldrlg for me. t�. ( ) I am a home owner performing all the work-myself. U 0'4�5N NOTE:please be aware that whilo homeow0c-who cmPloy perzom to do m.i__nica r,c=stretioo or t-cpa r work on a dwelling of not more tttsn three units in which the homeowner r=dcs or oa the pound appur-tcnan1 tbaao an not geocralty ooaaidacd to be cmploycn undo tha wvtkces ooa px�ect Acct(GL152,ss t(5)�application try a homcow=for a Gccax or pcYmit may cvidcnoe the legal rtatw of an employer under tha Workcra eornpoos tion Ac[ I undcntaad that a copy of thi:"1 r�may bo forwarded to the Department of Ludustrial Accideat>Ofroo of losursnco for the coverage vcrif cation aad(scat failure to scarrc coycnrgo unda scctioa 25A cf MOL 132 can lead to tha impos6oa of aimmsl penalCa comisting of a fine of up to S 1,5(X1.00 and/or im xisoamcat of up to ow).c&,and ci pcaaltics io the form of a Stop Work Onia and a fum of S 100.00 a day tga/iml M-- 4Signed s \aday of dC 199' FCCdcp=t>rr�altraaooly j Permit Number ( Map# Lot# Licensec/PcrnlitteC 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 Dcpn_, n t 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 park.Lng) # 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. , _1 1 DATE: Cc (` �t 7 APPLICANT'S SIGNATURE . l NOTE: lasuanoe of a zoning permit does not relieve a a plioant's burden to oomply With ali zoning requirements and obtain all required permits f the Board of Health, Conservation Commission, Department of Publio Works and other a liooble permit granting authorities. FILE # OCT 1 61997 File No. � t ZONING PERMIT APPLDMTION (§10 . 2) PLEASE TYPE OR PRINT ILLL INFORMATION 1. Name of Applicant:V\ 2n, i"A y c' lJ %�S s `} M 61, Telephone: a - ( "(Address: _ (� 2. Ownerof Property: Address:3 -'t-A � 5 I Telephone: 3. Status of Applicant: Owner _Contract Purchaser Lessee Other(explain): 4. Job Location: 3 6-11 —A Parcel Id: Zoning Map# zz/,�- Parcel# District(s): (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5, Existing Use of Structure/Property 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 Permit/Vadance/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) r- - FILE I 6 2 6P97 APPLICANT/CON'TACT PERSON:: J79 -7. � ADDRESS/PHONE: PROPERTY LOCATION: MAP PARCEL:— -- ZONW l THIS SEC'T'ION FOR-OFFICIAL, USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED ( TIT —__ Fee Pnid ]Rnifffin2 Permit Filled ntit Fee Pnifi c. Z a Addition to Ezietinv Arreccnry Strnrtnre Owner/(lrrnnant Statement n n�cP ,��/ �ld L �—"'- 3 Sete of Plnne /Pint Plan T OLLOWING 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 C mission 0 9 Signature of ui c r ate NOTE:Issuanoa of a zoning permit does not relieve an applioant's burden to comply With all _ zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Department of Publio Works and other applicable permit granting authoritles. City of Northampton REQUIRED INSPECTIONS BUILDING DEPARTMENT 2. seal Components in Place* 3. Complete Building* No. 997 Office of the Building Inspector Zoning Form No. 962912 Date 10/17/97 Fee$20.00 Check#2544 Page, 17A Parcel 88 ,Zone URA Section 127 ❑ Yes © No BUI]LDINGPERMIT * Plumbing and Electrical Inspections required THIS CERTIFIES THAT Pepin Roofing before Building Inspections has permission to strip 2 layers over kitchen,install SBS modified bitumus Inspection on Site—Foundations situated on 3 Mountain St - Polly Willard roof 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 , P ISES Certificate of Occupancy Building Inspector