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Zoning
Miscellaneous Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 1024 5- Alterations
NORTHAMPTON, MASS. 1 i 1 1 19 �1 Additions
Repair
APPLICATION FOR PERMIT TO ALTER
(�'� Garage
1. Location U K va^ R' � & Lot No.
2. Owner's name VVX-'a - q-4"'� Address
3. Builder's name a k- Address Vt/VV4'k- Yt tN -�9
Mass.Construction Supervisor's License No. CS Expiration Date
4. Addition
5. Alteration 1 -,v
-
t Q
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 aN1
Zz
11. Distance to lot lines �i °•" �Q t �-��C 4L' ��( �- —
12. Type of roof 1� Erik
13. Siding house
14. Estimated cost:-
U" '" The undersigned certifies that the above statcmcnts are we to the best of his,
`( knowledge and belief.
ignature of responsible app,icant
Remarks
EMW
.�:.. ... �.. a
Al
OAT
s e JUL 81999 Crzi�r oaf �nx�l�ttnt��un ,
� � 1 ynaSfatC4ASr1lf -
s DEPARTMENT OF BUILDWG INSPECTIONS
212"Main Street ' Municipal Building
Northampton, Macs. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
Oicc.rn permitter)
with a principal place of business/r�e(sideence at:
(Phone#) o`[
(str-.t/ci /statrhip)
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 woriang 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:
(Name of Contractor) (Insuranc:Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/PoUcy Number) (Expiration Date)
(Name of Contractor) (Insurmcc Company/Policy Number) (Ea-pimtion Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(nflzr4l additiocal shoat ifnooc=xy to include infoxniatioa paujaing to all o�)
( am a sole proprietor and have no one working for me.
( ) 7 am a home owner performing alt the work myself.
NOTE_plena be aware that WbDo hoa=wocra who employ pczso=to do m•i„+.,..nce coostuctioo-or repair work oa a dvm1&g of
not morn than tbroo traits is which the bomoow ncr rt=des or oa tba Vwz ds TV=unant tbrido arc not C.>aaUy coasidcrod to be
amployrn tinder tbo woriecex ooaTcn&atioa Act(GL152,=1(1)),appliczbou by a homeowner far a Gecmx oe permit may evidcaoo tbo
legs!o-w of as omployer under the Workoet compamation AcL
I undetsl,itad tbrd a Dopy of thi:mtema�maybe foevvaraied a the Department of Industrial Axidaoa101500 of Iawr,<oeo for the
oava'&c writ ended turd that fsib=to encore covanso tinder soctioa 25A of MOL 152 can lad to tbd imposi$ou of ee=iad.Pe-Wts .
00am sag o f&Eme bf up to S 1,500.00 wdlot 64xisoamxrd of tip to ore year and dvtl pcadl cs is the fain of a StoP Waeic Order and a '
fWa of 5100.00 a day tpinst MCL:
For meow use only
'- Permit Number
lvf2p4 Lot 0
` Sipature ofLiamscc/Pcsmittce
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 COMPLE'T'ED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This column to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&p_eved par king!
# of -Parking Spaces
it rof Loading Docks
Fill:
Avolume--& location)
13 . Certification: I hereby certify that the inform ation contained herein
a
G is t---u accurate to the best of my knowl�c .
DATE: APPLICANT's SIGNATURE
NOTE: lusua oe kpf a oning permit does not relieve an a ioanCs burden to oomply Wit4-ill
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission, Department of Publio Works and other applionble permit granting authorities.
FILE #
r{
t JUL Q 19,90 File No.&
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: Y-y-
/` — --
Address: `� L'✓ rQ--R, 10W Telephone: 1
2. Owner of Property: r °` �Q�-
Address: �o Telephone.
3. Status of Applicant: Owner ✓ _Contract Purchaser Lessee
Other(explain): /
4. Job Location: — 6 l (7�a
Parcel Id: Zoning Map#—.- /� Parcel# 1�� District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5, Existing Use of Structure/Property
6. Description of Proposed UseMorkJProject/Occupabon: (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 Permi dance/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#BP-2000-0019
APPLICANT/CONTACT PERSON Gerry Shattuck
ADDRESS/PHONE 40 Munroe St (413)584-6265
PROPERTY LOCATION 69 FOX FARMS RD
MAP 17A PARCEL 156 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Eilled out
Fee Paid --'
T_ypeof Construction: REMODEL BATHROOM _
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 058422
3 sets of Plans/Plot Plan
THE F LOWING 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
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission
1
Signature of Building Official Date
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.
I I ,
69 FOX FARMS RD BP-2000-0019
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block 17A- 156 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-2000-0019
Project# JS-2000-0023
Est. Cost: $7000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Gerry Shattuck 058422
Lot Size(sq. ft.): 19819.80 Owner: ROWE PETER N&BARBARA C
Zoning:URA Applicant: Gerry Shattuck
AT.- 69 FOX FARMS RD
Applicant Address: Phone: Insurance:
40 Munroe St (413) 584-6265
NORTHAMPTON 01060 ISSUED ON:711211999 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL BATHROOM
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation: y
Final: Final:
Rough Frame:
Gas Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 7/12/1999 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo