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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. - /t-� F Alterations
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NORTHAMPTON, MASS. � ' 19 5 L Additions
APPLICATION
% �
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location 0!S, C4 � %� f Lot No.
2. Owner s name Address
3. Builder's name 1-2 %b- .1 � yf t i Address SAS/ , X r?�/��1C�j ,�i�JF��;�/�N �f`/
Mass.Construction Supervisor's License No. 1D Expiration Date ' elf '
4. Addition
5. Alteration
6. New Porch / Lra —
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 1/F
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
Signature of responsible opp,icont
Remarks
�0 4Kt{AMp�,0
r.. ..
a a9 Crif laf Wart4ampt n
j
PPP`: SEP 3 11998 r�B13' TMENT OF BUILDING INSPECTIONS
J J -
21 Main Street ' Municipal Building
DEPT OF`t" ` Northampton, Mass. 01060
WORKER'S CONi TENSATION INSURANCE AFFMAV r
L)rp �cJC
(licenser/permi ttee)
with a principal place of business/residence at:
4u 3 V WP6H 08 611th (phone#) 913(o Z36yo6'
(str�tici ty/state�a p)
do hereby certify, under the pains and penalties of pcquq) that:
(SC) I am an employer providing the following workers compensation coverage for my
employees working on this job.
TRAQ(0125- r) IPUZ 431 (1 83 `)90_ —
(Insumnc-- Company) (Policy Number) OlKpiration Date
O 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) (Expiration Date)
(Name of Contractor) jnsurancr- Comoa:ly/Wtier Numc.,r) (Expirtion Date)
(Name of Conn-actor) (Insuranc: Compauy/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(aaach additioail slb,-c if mtc-r uy to iaclu6c vaformsticn pctai ring to all cYcuradon)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:plcssc be aware that wbiro h0a3axacn wtw airplay pasow to do ax&i„t�coatudioa or repair work on s dwelling of
not Eno"than throo units is which the bamcowacr r=ides oc ca the yr ua lb apVu t,=t tbcrctn"I cot Ecoa-24 ooasidacd to be
cmployas under the tvorka ccaTc r4on Act(GL152,=1(5)),application by a homcowar for a Gccox cc permit may cvidcnoc tho
legsl aahto of an employoc undor dw Workoet Comp=i-x a Act_
I undcrsts nd tbA a copy of this rratcmcat¢ray bo fory iudod to tho Dtparimm2 of Industri a1 Accidmt> Offioa of Imu�for tin
covcrage vaificatioa and that failure to secure oovcrngo under soctioa 25A of MOL 152 can lead to the imposition of aimimtl patalEcs
oomisliag of a fmc of up to S1,500-.00 WN0c bmprBOUrncaf of up to ooe year nd civil pcn&WC3 in the form of a Stop Work t?rdcr
firms of51oo.00.any-gains;tic
Foe dq=W=W uao eah!
Permit Number
f l l l Ivfap# Lot# t
Signahuc ofY iacnsce/Peruiittce nate
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 X
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
Thin col== to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size X / v J
f 12 Frontage 5~
Setbacks - frnnt
side L:27 R: L:.. 3 R:
- rear
Building height
Bldg Square footage �-
%Open Space:
Lot area minus bldg
&paved parking)
# of -Parking Spaces I f
f of Loading Docks 1
K,l O
Fill:
{vol-ume-& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
D2 E:11 9-3_.CZq) APPLICANT's SIGNATURE
NOTE: Issunnoa of a zoning permit does not relieve an applioan&s burden t comply With)ajj
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
3,
.. File No.gp�iv
�Z6NING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: a.;
t
Address: qy 3 A! („_r f XZ `i % Telephone: E�
2. Owner of Property: ,°��i'/ �y % •
Address: Telephone: , S--/-D .3 }�
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# 171+ Parcel# District(s):-,
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of StructurelP rope rty
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
7. Attached Plans: X—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— X 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 X 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#BP-1999-0269
APPLICANT/CONTACT PERSON Robert Hogencamp
ADDRESS/PHONE 443 N Washington State Rd (413)623-6408
PROPERTY LOCATION 18 CLAIRE AVE
MAP 17A PARCEL 116 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildine Permit Filled out
Fee Paid t � (s' X ly L''
Type of Construction:
New Construction
Non Structural interior renovations
Addition to Existinp, -
Accessory Structure
Building Plans Included:
Owner/Occupant Statement or License# °
3 sets of Plans/Plot Plan
THE LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
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
Well Water Potability Board of Health
��.a., .��� ��d�5ervatio ommission
Signature of Buildi fficial Date
W.Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
Department: Reference No: BP-1999-0269
....................•.•............
Building, Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Building- Renovation REC-1999-000657
PaidB.y:.......................................................................... 'P"a" ---F...u-1.•-•----:10 n...........
Robert Hogencamp Thu Sep 03,1998
...... ...... .... .. . ...... ......
.Received..By.:................................................................. .Check.No:...................Linda Lapointe 3986
.........................................................................................
......................................
DEPARTMENT'S COPY Amount: $40.00
...................I.......
DEPAWI'NIENT FILE COPY 18 CLAIRE AVE
CITY OF NORTHAMPTON
BUILDING PERMIT
Owner's pulling their own permits or dealing with unregistered contractors for applicable work do
not have access to Guaranty Fund(MGL 142A)
Issued: Permit No: Inspector: Tracking No.: Fee:
BP-1999-0269 $40.00
GIS#: Mau Block: Lot: Address: Zoning: Use Group: Lot Size:
1426 17A 116 001 18 CLAIRE AVE URA 9016.92
Contractor: License Type: Insurance:
Robert Hogencamp CSL Workers Compensation
Address: License No.: Insurance No.:
443 N Washington State Rd 009103 7PUB431XI83
gya State: Zip Code: Phone:
WASHINGTON MA 01223 (413) 623-6408
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0575 alteration-addition $5,000.00
Description of Work:
CONSTRUCT 16' X 12' SCREEN PORCH
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: