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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Teel.No. Alterations
NORTHAMPTON, MASS. MAY 0,1 I9 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
(�� tv� _ Garage
1. Location i Z 5 ' "o P,T tj , t Pt- 's� FLO'R CN C C Lot No.
2. Owner's name FR A^t c cr-5 - I L L C Y Address S AY``£
3. Builder's name tb A�`$ Address 9 S�4 ff4C-P-Ds 4f°L. -°�
Mass.Construction Supervisor's License No. 05®c7 9 9 Expiration Date H 2- 12 °o
4. Addition
5. Alteration ADD T 1 o tJ O F 'FU L L gP T(A c)+J F t R Sf T=(-o o 2
6. New Porch
7. Is existing building to be demolished? VJ Z>
S. 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 3s o o
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
aw�k, &,
s nature of responsible appicant
Remarks
jafmo
MAY 2
C
sIN
---—400'
For, -F�N l I L.L :"y r-T
1255 MP1 e LC 'DT., FLoa ctj C-C, MA . 4t3 - 584- H62-co
7 ' Y By ED �A Zs�g 9 !-� 1� t �Z 5 a w
7„ y
9+ Y
z0 pr°� MAY 2 I i
998 ,�,�
a •.t }.�acsaxcansctta
DEPARTMENT OF BUILDWG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORS{ER'S COMPENSATION INSURA-NCE AVTT
ED -Z�A?
(11PCI-mittce)
with a principal place of bul :
siness/residence at
SIB HC6�DS t)C)L_LDw (phone#) `113 - 536 21
(Strom city/stalrJnp)
CIO hereby certify, under the pains and penalties of perUuy, that
( ) I am an employer providing the follollving worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Date)
O 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) (Lnsuranc: Company/Poticy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/PoUcy Number) (Expiration Date)
(Name of Contractor) amsurance Compan)'/Poucy Numbu) (Expiration Dale)
(Name of Contractor) (Lnsivance Company/Policy Number) (Expiration Date)
(--h-ddb onI:hoct if o..ary to iactudc infixmat oa pertniuing w all o�atraclan)
I and a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be award that whilo bomco mcn who cmplay pasom to do M.jrjfmjnix coczucdon'.or repair work on t dwelling of
not moo than tbr-units in which the hoWoowncr r=dca .r oa tbo gruunds appurtenant lbado arc oo(gcaaally ooasidcr d to be
cmployrra under tba wockcr`s oomp=s4ca At(GL 152 ss 1(5)} application by a homcownar far a Uc o=oc pamit may evidcnoe the
legal clams of an omployor under tho Woriccet compo Aioa Ad-
I undcr:txnd that a copy of this c1 f—d may bo forwarded to d.Dcpartmco2 of L> zlriJ Ac-&=&BOO of Iasur.noo for tha
covcsxgo crificaiioo and that U=to toot=covcrago under soctioa 2SA of MOL 152 cau,lend to tbd impm>ttaa of crimixW pca&Wcs
o0a istmg of a&ne'of up to S 1500.00 andlor impruoameni of to.one y=and civil pennies in the form oC n Stop Work Order and a
firm of SI00.00 st ALy tpinsi mc,
For&Pntm- l upo only
Pcnnit Number _
3t Sapp -
Y��.. sig�4alurc Lt crinittoc _ .
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 comma 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: J
(Lot area minus bldg
&paved parking)
# of Parking Spaces
# Hof Loading Docks
Fill:
_(volume--& location)
13 . Certification: I hereby certify that the information contained herein
isrr true and accurate to the best of my knowled e.
DATE: 512tI � r
APPLICANT'S SIGNATURE
NOTE: Issuance of a zoning permit does not relieve an applioa s Vurden to oompty witty 4kll
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applloable permit granting authoriflea.
FILE #
4.�
MAY
File
of
ZOLVING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: ED 3p�zt-\D
Address: <) Si1 �'t1£��JS C�Duolvj, LM-5 Telephone:
2. Owner of Property:
Address: 1 S M O RI-0 I 1► i S Telephone: L4 tai 5 84 - LA e2�
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: 125 WOXT-0 1"' r ? LC ST I-Lo4ze�.x.t
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE D IN BY T BUILDING DEPARTMENT)
5 Existing Use of Structure/Property C'y►'`"C
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
(ADDI-C( ON of _6,(VTv,2ooM -T-D 'F%(z,JT- Fi_ooeF, iNf`rl�itJ �CISTihNt-
�(����SPI�C�
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 '>I 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 _X 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
1 R I
MAY 2
APPLICANT/�ON4TACT PE ON: �a
j,FP T Q DRESSIM' NE:
PROPERTY LOC TION: ✓�'�� �� O I
MAP PARCEL: ? ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION_CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM EHIED 0111
Fee pflid
Fee PA if] IeY2 2
Additinn to Existing
d6
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 Conserva ' Commission
•-<`''�
Signature of Buil pector Date
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 Northam p ton REQUIRED INSPECTIONS
} '
BUILDING DEPARTMENT 2. Strucntural Com onents in Place*
e Components
3. Complete Building*'
®. 1628 Office of the Building Inspector
Zoning Form No. 963567 Date 5/28/98 Fee$40.00 Check# '1819
Page, 17A Parcel 208 ,Zone URB Section 127 ❑ Yes ® No
BUILDING PERiN/H r
*Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Ed Jazab before Building Inspections
has permission to add bathroom within existing space Inspection on Site--Foundations
situated on 125 North Maple St - Frances Tilley 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 Manufacturer's information: windows,vinyl siding,roofs
Smoke Detectors(Fire Department)
and woodstoves
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON PREMISES
Certificate of Occupancy
Building Inspector