05-024 (6) � a
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No�/2' �� 45 Y4/ Alterations
NORTHAMPTON, MASS.
/ 19,� Additions
Repair
' APPLICATION FOR PERMIT TO ALTER
Garage
1. Location Lot N ch
2. Owner's name 'a Address'l -0
3. Builder's name Address r
Mass.Construction Supervisor's License No a!V/, c> '��i Expiration Date eke �?
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 (J. G �
The undersigned certifies that the #9 s[ ements are true to the best of his, her
knowledge an belief.
Si re of responsible appicani
ice"
Remarks ; ��'
0 4'�t�PTO
a 6 ffl:ssachnsctts ~
e ♦ 1 "aEf at',
m DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building 'o
Northampton, Mass. 01060
WORKER'S COMPENSA'T'ION INSURANCE AFIi'IDAVTT
(li c�nsec/per mi ttee)
with a principal place of business/residence aL
(stiest/city/statcjnp)
do hereby certify, under the pains and penalties of peFjuly, that:
( ) I am an employer providing the following workers compensation coverage for my
employees working on this job:
(Lasu 3nce Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor or r homeowner (circle one) and have hired
the contractors listed below ho have the fo owing worker's compensation policies:
(Name of Contractor) (Insuranc; Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expirati on Date)
(Name of Contractor) (las-Li=cc Compaay/Poticy Numlx r) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional shoot Y---uy to nchx5c nforauti oo pc11aiaiug to till oonfrnctors)
(j� a sole proprietor and have no one worldng for me.
( ) I am a home owner performing all the work myself.
NOTE:please be awue that whiles homcrno. c who cmplay pcnom to do �oJnSructioa or repair worst an s.dwelling of
not-cre than tbro units in which the ho=owocr maiden or on tho grounds appurtenant tberdo arc oot gcnctally oomukrcd to be
mWlaY—under tho twticct'i oompawAtiar Act(GL152,n 1(5)),application by a homcowna far a liccn-a pr-mit=Y cvidcaa tbo
]cga!etatus of an omployor under tho Wockces Compematiou Ace.
I understand that a copy of th z ctar.emcut may bo forwarded to the DeQartarco2 of Indust d A=&d &Othoo of Inzur.neo for the
coves age vctificalioo and that failure to secure covcmgo undo suction 25A of MGL 152 can lead to the irrrpoi -of criminal pcaaltica
eomist=u of a frne'of up to S1,500.00 and/or bmpriso� of up to one year and civil pcnsltics in the form of a Stop Work order and a
fum of S 100.00&:&y against mc.
n For&vntn=,tA1 trso—1-
Permit Number
Mai----
r;:,_„ igiiaEure Lot#
of
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 column to be filled im
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
OVOOpen Space:
(Lot area minus bldg
&paved parking)
# of -Parking Spaces
# fof Loading Docks
Fill:
-(volume -& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my know edge.
DATE: j- " 70 APPLICANT's SIGNATU `
NOTE: Issuance of as zoning permit does not relieve an appli a s er to oomply With all
zoning requlraments and obtain all required permits from the Boa of Health, Conservation
Commission, Department of Publio Works and other applionble permit granting authorities.
FILE #
1998 Q /�
File No. / 7 t
ZONING PERMIT APPLICATION (§10 . 2
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:'
Address: one: 4113
2. Owner of Property: ;a
Address �j �rXr� �—��� , Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: -2
Parcel Id: Zoning Map# Jr Parcel# .� _ District(s): tX1 1'511<9
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5, Existing Use of Structure/Property
6. Descri lion of Pro sed Use/Vllork/Pr j t/Occupation- (Use add'' pa sh if necessa
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 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 # k j
��PLICANT/CONTACT PERSON:� ''� �✓
1��;A,DDRESS/PHONE: � l'
PROPERTY LOCATION: �--
MAP PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERAHT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FOR FILT ED OUT
iguilding Permit Filled allif
Fee Pnid
�-
D ° /`/
Additinn to Existing
Accessory Strurtime
7
THE OLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
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
e .. 'Y ,�if`d Health Well Water Potability-Bd Health
Permit from Conservatio ommission
Signature of Building • ector D
NOTE:Issuance of a zoning permit does not relieve an applicant's burden to comply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
City of Northampton REQUIRED INSPECTIONS
A e
e
BUILDING DEPARTMENT 2. S�r�tural Components in Place*
I Complete Building*
NO. 1531 Office of the Building Inspector
Zoning Form No. 963477 Date 5/5/98 Fee $20.00 Check#4285
Page, 5 Parcel 24 ,Zone RR/WSP Section 127 ❑ Yes 0 No
BUIULDINGPERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Tom Boyle before Building Inspections
has permission to replace 10' X 14' front porch floor boards 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 pemiit.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 I K 12=`�
** Install per Manufacturer's information: windows,vinyl siding,roofs Smoke Detectors(Fire Department)
and woodstoves
Other
THIS CARD MUST BE DISPLA D PjA CONSPICUOUS PLACE ONJHE PREMISES
Certificate of Occupancy
Building Inspector