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17A-156 (4) > Cp��7 v � o• � v m -ti O = O C = W f -� 07 70 p' '1 cn Z z 3 rn � c m z D A Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.N—J`- Alterations ?�!`1 E NORTHAMPTON, MASS. ��' Additions APPLICa ATION FOR PERMIT TO ALTER Repair f Garage 1. Location Lot No. 2. Owner's name Address a 3. Builder's name we C Address 2 � J Mass.Construction Supervisor's License No. Expiration Date 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 13. Siding house 14. Estimated cost:- f The undersigned certifies that the above statements are we to the best of his, her knowledge and belief. Signature of responsible app,icanl Remarks 4-tylAMp�, r �O Ok - $ B �laisxcflnsctta DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT r � (licensee/permittee} with a principal place of business/residence at: (phone#) (seet/ci ty/statrhi p) do hereby certif},, under the pains and penalties of pegury, that: O I am an employer providing the follo"vving worker's compensation coverage for my employees working 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) (Insurance Compauy/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/PoLicy Number) (Expiration Date) (Name of Contractor) (Insuran(—_ Company/Policy Number) (Expiration Dale) (Name of Contractor) (Insurance CompanyNolicy Number) (Expiration Dale) (attach additioeil:hose ifnoo=sary to inc}elde informaIIoa pcztaiaing to all oxdracton) ( am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that while homeow=3 who employ p==to do m*md=aac,oonstlu oa or repair work on a dwcWng of not MOM than throe units in which the homeowner r=da or oa tho grcxrnds appuete=a thercte art not gcmetaity coandert d to be emPloy+eta undo tbo wmi=u oompens4ca Act(GL152,s 1(5)),application by a homeowner for a licct>,so or permit may evidence tho legal clatus of an employer under rho W ociceez Compeosatioa AcL I underatind that a copy of this statcmest may be forwarded to the Departam of Industrial Acd&o&t?ffioo of In uczoce for the oovcmx verification and that failure to ter=coverage un kr section 25A of MOL 152 can ltad to the imposition of tz MAI Penalties ooh of a fine of UP to S1,500.00 and/or imprisorm of up to one year and civil pca&W s in the form of a Stop Work order and a firm of 3100.00 a day against tt 17 For departa=w use 0131Y Permit Number Mao y Signahue of Liocnsee/Permittcc UaiLee I/ ` r. i s ti_ 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 Coln= to be filled in by the Building Department (Required I 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 &paved parking) # pf Parking spaces # '6f 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: j -3C� i`� Sl APPLICANT's SIGNATURE NOTE: Issuanoa of a zoning permit does not relieve an #ppilaanVa burden to oompty Witir'all zoning requirements and obtain all required permits t m the Board of Health, Conservation Commission, Department of Publio Works and other applionble permit granting authorities. FILE # 1��,P 3 i { t File No. IJ ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: Address: f Telephone: �C 2. Owner of Property: Address: Q �/�,�,'Ln✓!�J /� Telephone: 3. Status of Applicant: Owner Contract Purchaser�essee Other(explain):` 4. Job Location: Parcel Id: Zoning Map# ,?` Parcel# ,d :_ District(s): L- (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5, Existing Use of Structure/Property 8. 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/Variance/Finding ever been issued for/on the site? NO DON'T KNOW 1," _ 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 V' 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 # MAR 3 1 1999 APPLICANT/CONTACT PERSON: ADDRESS/PHONE: D .L PROPERTY LOCATION: 2 Z� _&'1 40i ? MAP PARCEL: I�:l ZONE 14.1 THIS SECTION FOR�OFFICIAL USE ONLY: PERNIIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM EHLED OUT Fee Pnid Iffididing Permit Filled mit Fee Pnifi Arressnry Strnrtnre Ruildi Plc�nc Tnr111ded- 1`7 _1 THE�KLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION' 11//Approved as presented based on information presented Denied as presented: Special Permit and/or Site Plan Required under: § PLANNINGBOARD ZONING BOARD Received &Recorded at Registry of Deeds Proof Enclosed Finding Required under: § w1ZONING 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 r v f,Health Well Water Potability-Bd Health 7a. r !Permit from Conservatio ommission 1 Signature of Building lrwklor Date NOTE:issuanoe of as zoning permit does not relieve an applioant's burden to oompty with all _ zoning requirements and obtain ail required permits from the Board of Health, Conservation Commission, Department of Publio Works and other applioable permit granting authorttles. tVW F�� "•� City of Northampton REQUIRED INSPECTIONS . BUILDING DEPARTMENT 1. Footings and Walls 2. Structural Components in Place* 3. Complete Building* No. 1404 Office of the Building Inspector Zoning Form No. 963346 Date 4/1/98 Fee$20.00 Check#375 Page, 17A parcel 156 Zone URA Section 127 ❑ Yes © No BUI]LDING PERMIT * Plumbing and Electrical Inspections required THIS CERTIFIES THAT Jim Roberts before Building Inspections has permission to strip & shingle roof Inspection on Site—Foundations situated on 69 Fox Farms Rd - Peter Rowe 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 provisionsof 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 YHE PREMISES Certificate of Occupancy _°