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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS.y 19 Additions
Repair
APPLICATION FOR PERMIT TO ALTER
Garage
1. Location�a A A0,V2,0 Lot No. _
2. Owner's name /1UW XOl-ZA Address j, 6 el
3. Builder's name/� ll1l�'� = :1,9? Address yZ
_ S�
Mass.Construction � `�/e ction Supervisor's License No. t; l v 5;7 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-4 ,�26
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible app icant
Remarks ' //
4�tw.tpT
a� �0 0 -
$ 6 j�+lassxciinsctfa
m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street e Municipal Building 'o
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(licenserlpermittee)
with a principal place of business/residence at:
�+ / sl �t'J j�i�✓ /mod csr�'�C% (phone
(strccucity/statd2rip)
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 Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(auadl additio-d short if nooc—ry to inc}udc inf yr n oa pertaiaing to all ooatr d )
(VI 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 whilo homcowacra who employ per, a=to do maiutc�coasavctioD or repair work on a dwelling of
Dot mono than throe units in which the hoo3oowncr raids of on the ground,appurtenant iberety are not gencrally ooandcred to be
emPloyera under the workca compc:nutioa Act(OL152,ss 1(5)),application by a homeowner fora liceme cc p-md may evidenoe the
legal ctxtus of an employer under the Wod eea eompea cation Act_
I understand that a copy of thin ru cmmi may be forwarded to tho I)Wartmm of Industrial Aocideati Offloo of Fannon for the
coverage vaifiration and that failure to secure coverage under sodion 25A of MGL 152 ran kad to the impostioa of criminal P-Awes
004sistw9 of a fine of up to S1,500.00 mWor imprisoameut of up to one year and civil pcoalties in the form of a Stop Work Order and a
fins of 5100.00 a day against the
For deput=Stn]—Only
Pcrmit Number
Map#�'� •_Z/..J�/ _Lot#
Sigriahne of Liocnsee/Permitiee
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 MAST BE COMPLETED, or PERMIT CAN BE DENIED DOE TO
LACK OF INFORMATION.
This columm to be filled in
by the Building Llcpar tment
I 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
&paced parking)
# of -Parking Spaces
ht. of Loading Docks
Fill:
4 volume--& location)
13 . Certification: I hereby certify that the information contained herein
G 1 is true and accurate to the best of my knowledge.
_
DATE: y-2/-9 * APPLICANT's SIGNATURE �pp �NOT E: lasumnoe of a zoning permit does not relieve an cant's burden to oompty witF�~all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commisalon, Department of Publio Worku and other applionble permit granting authorities.
FILE I
t _
APR 2 1 1,998 y�"//
File No/r 3 p2F
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: x�
Address: ��� S' � Telephone:
2. Owner of Property: A'/ 'uw
Address: O Vl /'iz Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# _ Parcel# 017 / District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
2N"5llxy-// Vi N� / S"�c �-/9
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/Vadance/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)
r
U ? 'y.
FILE # U
1998
APPLICANT/CONTACT PERSON: ZV-6,5
ADDRESS/PHONE:
PROPERTY LOCATION:
MAP _ PARCEL: ZONE PL
THIS SECTION FOR.-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Riiilding Permit Filled Qjit
NtwCnnqtriirtinn
Remodeling Tnterior
Addition t Existing
3 ,Set,. of Plans /Pint Plan
:✓
T11E,POLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION'
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
fro ons�atio ommission
Signature of Building Wector Date
NOTE:tanuanae of a zoning permit does not relieve nn applioant's burden to oomply With ail
_ zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioabie permit granting authorities.
City of Northampton REQUIRED INSPECTIONS
} 1. Footings and Walls
. BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
No. 1482 Office of the Building Inspector
Zoning Form No. 963428 Date 4/22/98 Fee $20.00 Qmeck# 2678
Page, 5 Parcel Zone 24 , RR/WSP
g Section 127 (J Yes No
BUI]LDING PERNUT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Ed Corbett Jr before Building Inspections
has permission to install vinyl siding Inspection on Site—Foundations
situated on 264 Audubon Rd - Ronald Korza 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 Manufacturers information: windows,vinyl siding,roofs Smoke Detectors(Fire Department)
and woodstoves
Other
""
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON THE REMISES
Certificate of Occupancy
Building Inspecto