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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 1 q Additions
a APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location / `/3 �• f�� k7lez,4- Lot No.
2. Owner's name Address/S3 ti,')01lApl
3. Builder's nameLl md�ez� /��.�% Co Address/S 2 IQ�� !� :�/ !2 I- A a L,
Mass.Construction Supervisor's License No. Z C /a !! G Expiration Date G — 2 s 9 S
4. Addition
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 S^ /,I
13. Siding house
14. Estimated co t:-
The undersigned certifies that the above statcments are we to the best of his, her
knowledge and belief.
ignaturt of responsib/t app"..,
Remarks o v 2
4KttAxrpr � �k
OCT 2 o 199Y
DEPARTMENT OP BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORTCER'S COMPENSATION INSURANCE AFFIDAVIT
7`t a ko p e em jCl .,.. Q r1 41 N'1 ^r C.M .
(liccnsccJpermittcc�
with a principal place of business/residence at:
f, : d R 0 10 D-A.e-p (phone#)_S°t q7713
(strcet/ci /Aatd2ip)
do hereby certify, under the pains and penalties of pedury, that:
(.�'I am an employer providing the following worker's compensation coverage for my
employees worlring on this job:
7i1,4-v,A>r-e c- 3 t 7
(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/Poticy Numbcr) (Expiration Date)
(Name of Contractor) (Insurance Comaany/PoLicy Number) (Expiration Date)
i
(Name of Contractor
(Insurance Comp;ul),/Policy Ntlmlxr) (Expiration Date)
i
(Name of Contractor) (Insurance Company/PoLicy Number) (Expiration Date)
nal
(attach additio shed if ncccn ry to inclucic infonn ujoo Pcrtainirrs to all cc'&acton)
I
( ) I an a sole proprietor and have no one workng for me.
( ) I am a home owner performing all the work'myself.
NOTE:please be aware that whi]o homcrowncts who employ Pc.onr to do R.j. r,. cons>rttetion or repair work on a dwelling of
not mete thsn throo units in which the bomoowncr rmdca or on tba Clr n appurten.r,t tbetdv uc not Ccmnlly ooaridcrrd to bt
employers under the wprktel cation Act(GL152�-t(5A application by a homeowner for a Gaase or permit may evidence tha
legal ctattra of an au:ployec under thn Workcel COmpecx ation AL
I undersund thst a oopy of this c**tcau- -+rruy be fotwnr to the Dqp to xxt of Ir�duairial Aoeideab Offioo of In or tho
coverage vrri icatioo and that failure to sccurr coves agro tuzdcr scUioa 25A of MOL 15Z cm Icad to rho imposition of criaihW peaaWcs
oomiumg d a fiao'of up to S"300-00 500.00 and/or kaPisoun'-d of up to one)iar and dv�pctnttics in the form of a Stop Worts Order and a
fum 0(510.00 a day agaia:a Me--
Signed this o _____day of p c- 7 1997 FordgMtmoda —only
n Permit Number
Signauwc of Liccasr�/Pctmittce Map# Lot#
�. ,
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 column to be filled in
by the $uildiag Department
Required
Existing Proposed By Zoning
I Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear -
Building height
Bldg Square footage
%Open Space: _
(Lot area minus bldg
&p=.c,ed pa:king;
# of -Parking Spaces
# Hof 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 knowledge.
DATE: c-7oTT g o 7 APPLICANT's SIGNATURE
NOTE: lesuanoe of a zoning permit does not relieve an applionnt's bVrdan to comply witta~ It
Czoning requirements and obtain all required permits from the Board of Health. Conservation
ommission, Department of Publio works and other applicable permit granting authorities.
FILE #
OCT 2 01997
File
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: A v%,% Ike 24 T 20 o!� .,— P Co
Address:/ 9 7 Zoe k 1j ; it k j !^t&D i_TTelephone: $q `e `L q Z ,3
2. Owner of Property: o�j{R"t ��n A a k S
Address: l 3 N• 1►'t�Tf F I ,Z�...c Telephone: S'S e. j a
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: 19 /L,'1�C71 ►r�(� (= (e.(I yy- - c —e Parcel Id: Zoning Map# / / Parcel# / 9/ District(s)Yt/jt-
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5, Existing Use of Structure/Property
6. Description of Proposed UseNVork/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 KNO%' / 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 # 962919
1
OCT 2 01997
APPLICANT/CON 'ACT PERSON:
AfDDItESS/PHUNE e G'
PROPERTY LOCATION: C�2 -
MAP J l7 � PARCEL: l f ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONINCI FORM FELTED OUT
Fee Pnid
Rnilfjin2 Permit Filled njit
P aid t/
0 U — ✓
Accessory 'Striichire
c' / 3 i�� ✓
THE ALLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
?/'Approved as presentedibased 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 ' fro ons at' o
G 12- - y'
Signature of Building ingKctor D to
NOTE:issuanoe of a zoning permit does not relieve an applioant'a burden to oompty with all
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission, Department of Pubiio Works and other applioable permit granting authoritles.
? pity of Northamton REQUIRED INSPECTIONS
p
► ! 1. Footings and Walls
`'
BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
No.
1011 Office of the Building Inspector
Zoning Form No. 962919 Date 10/22/97 Fee$20.00 Check# 1150
Page, 17A Parcel 181 ,Zone uRB Section 127 ❑ Yes ® No
BUI[I-JDING PERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Amherst Roofing Co before Building Inspections
has permission to reroof over 1 layer Inspection on Site—Foundations
situated on 193 North Maple St - Robert Phelps 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 P CE ON ISES
Certificate of Occupancy
Building Inspector