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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. t f I ZZ�t Alterations
NORTHAMPTON, MASS. �`-}� '� 2L7 ' 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location v�a �? 11-x- t Lot No.
2. Owner's name V- Address
3. Builder's name �'� ;2 ��` � Address �' S 1LC Gam.
Mass.Construction Supervisor's License No. Expiration Date Gf 'k X
4. Addition
5. Alteration GK., zit
6. New Porch t�j
7. Is existing building to be demolished? ^y
8. Repair after the fire %-J
9. Garage N No.of cars Size
10. Method of heating
11. Distance to lot lines f SA
12. Type of roof rJ
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible app icon!
Remarks
t
� .
Gif� of 'Wart4aillptau
NOV 2 4 1997
3 ' �asaschnsrtta
.m
EPT O EPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSA'T'ION INSURANCE AFFIDAVIT
(licenseeJpermitlee}
with a principal place of bu nness/residence at:
(phone#)
(street/ci ty/statrJa P)
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 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 Comparry/Policy Number) (Expiration Date)
(Name of Contractor) (Lnnrrance Company/PoLcy Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(anach additioml shoe if neccauy to include infocinaIIoa pertaining to all ooatradnn)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:pltaae be awira that whilo homcowncm wuo employ peso=to do ma atrannco.o=sta c om or repair work ott a dwelling of
not more than throe units in which the bomoowacr resides or cc(Se grotcn&appttttenanttbwcto ace not Saxralty comide=1 to be
employers under the worke`s coapcnsr4oa Act(GL152,ss1(5)),application by a homeowner for a liocnse or p—ait may evidcaoe the
legs!elatua of an employee under the Workde Compomation Ant.
I understand that a copy of tiva rtatcmeat may be focwuded to the Dcpwtm of Ial al Aecidaf Off o0 of Imuraaoo for the
covaage vcnfieatioa and that failttre to ecaue coverage under secUoa 25A of MGL 132 as lead to the iarpos—of criminal penal -
oow.Leag of a Sae ofup to S1,500.00 and/(r kVr4omment ofup to one year sad civil penalties in the form of a Stop Wodc order and a
fum of 5100.00 a day against me
Signed this )—q't#_may of.-NQQ 1997 For&pntm —Only
Permit Number
1vfap# Lot#
Signatart:ofLi ermittce
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.
Thia —1.== 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 parkingf
# 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: - APPLICANT's SIGNATURE
NOTE: Isauanoe of a zoning permit does not relieve an applioanYs burden to oomply Wit4-ali
zoning requiremanta and obtain all required permits from the Board of Health. Conservation
Commisslon, Department of Publio Works and other applionble permit granting authorities.
FILE #
NOV 'L 41991
File No. 31) t
DEFT OF BUILDS, t ,'„' 't;_
c Ix ==---- `Ofi7ING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: f�' uhj\".,j
Address: Telephone: Qa `>( Z`LL•1
2. Owner of Property: Vk y'
Address: pct 'iii �;' �L d' Telephone:
Lt t 1
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): e�r�•r
4. Job Location: �?7L;• ” `- ��
Parcel Id: Zoning Map# Parcel# Cpt) District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of StructurefProperty 15�"y6,t' ip Cht'.t1 ' >\yO A '
6. Descriptiorl 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.
S. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNO;A.! )C' YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW >0� 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)
art
12...r FILE #
N► 2 41997
APPLICANT/CON ACT PERSON:
7EPT /PHONE: c t�
PROPERTYJOCATION: �Iax
MAP PARCEL: 6 ZONE -
THIS SECTION FOR-OFFICIAL, USE ONLY:
PERNIIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FnRM EHLED 0111
Fee pflid
3 Sets nf&lnnq,�Pint Inn
�-'
THE OLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
Approved as presentedfbased 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 Conservati ommissIGM
Signature of Building or Date
NOTE: Issuanoe of es zoning permit does not relieve nn applioant's burden to oomply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commisslon, Department of Publio Works and other applioable permit granting authoritles.
City of Northampton REQUIRED INSPECTIONS
' e 1. Footings and Walls
e
BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
No. 1120
Office of the Building Inspector
Date 11/24/97 Fee$100.00 Check# 7769
Zoning Fonn No. 963047
Page, 5 Parcel 20 ,Zone RR/WSP Section 127 ❑ Yes 0 No
BUIELDING PER.tvffl'
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Bob Reckman before Building Inspections
has permission to remodel master bath Inspection on Site—Foundations
situated on 395 Audubon Rd - Leeds - Leonard/Lisa Baskin 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 pem-tit.Expires six months from(late of issuance,if not started. Building Inspection—Rough 6C
Note:A certificate of occupancy will be:Issued by this office upon return Insulation Inspection n c!c_- 1-t e- �.
of this card sig od by the Plumbing,Wiring and Building Inspectors. Building•Inspection—Finish 4 K. 8
Smoke Detectors(Fire Department)
{ Other
THIS CARD MUST BE P SPICUOUS PLACE ON 1PRE ISES
Certificate of Occupancy ..... -
?'_Building Inspector