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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
Additions
NORTHAMPTON, MASS. 19
APPLICATION FOR PERMIT TO ALTER Repair
a Garage
1. Location-.-q(-, Lot No.
2. Owner's name &"Oe'ld
Address '76
3. Builder's name Address f �e)-1
Mass.Construction Supervisor's License No. //e Expiration DatefT-
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- "C "i t'd ('V,/- T- ro elre
The undersigned certifies that the above statements are true to the best of his, her
knowledge v&d belief.
4�z 4
AgWature of responsible appicant
Remarks
a 9� i I
JUN 91997
e � i3tiirbtratcta
e _
DEPT OF BIJ F,'NC*K'71 l ART1vfENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(licensce/permittee)
with a principal place of business/residence at:
,X 11%o C e 45�iaK C> (phone#)
(streeWcity/statehi 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 Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Poticy Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Dare)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additionl shoot ifnocciszry to indixre infonn don pertaining to an ooac edots)
( ) I 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 homcowucrs who employ person:to do mairdcaancc cooatiw ion or repair work on a dwelling of
not morn than throe units in which the homeowner resides or on the ground3 appurtenwt thereto are not generally ooandcrcd to be
employers under the workct's ootnpcnsaticn Act(GL152,n 1(5)},application by a homeowner for a license or permit may cvidcace the
legal siztns of an amployer under the Woricor's Compemation Act_
I undaztsnd thzt a oopy of this ctatemcat may bo forwartW to tbo Departmm2 of Iad-, d Accideab Of&oo of Inzurwwo for the
covctxge vai&caiioa and that failure to sw=coverage under section 23A of MOIL 152 can lead to the impost -of criminal Penalties
oomisting of a fine of up to S1,500.00 and/or imprisoumeaL of up to one year and civil peaaitia in the form of a Stop Work order and a
firm of 5100.00 a day against me.
Signed this _d of ,11�t t' 1997 For 6q ttaal—only J
Permit Number
Map:{ Lot#
Signature of LiccnseeR Uee
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 N0_4
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 pepartment
I Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
' &paved parking)
# of4Parking spaces
ffof Loading Docks
Fill:
'4 vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: APPLICANT'S SIGNATURE
NOTE: Issuanoe of a zoning permit does not relieve a�li-oaniV b rd n to oom wit
PP PIY 4..+Pk11
zoning requirements and obtain all required permits from the Board of Health, Conservtation
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
JUN 91997
DEPT OF BUILDING INSPECTIONS File
NORTHAMPTC; NI0101
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
G1-/L!
Address: ►'�(' l�`��%" Telephone:
2. Owner of Property Z"-'�
i
Address: -. Y^c .� Telephone:
3. Status of Applicant: _Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: �f t ✓t_c'
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE UILDING DEPARTMEN
5. Existing Use of Structure/Property
6. 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/Vadance/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)
t q
p i FILE
. LW APPWAN ONTACT PERSON:
s H'� NE: a C a 7
DEPT OF MILDIK INSPECT'ONS
NORTHAhiPTCN. ;' ^{ ,� t
PR(SPER"TI'i.00ATION:
MAP /2<4 PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONT'NG FORM FITIRD OUT
Fee Paid
Ridldin2 Permit Filler] nnt
o _ ✓
Additinn to Existing
Accessory qtmirtnr;
THE�LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION'
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
Septic Approval-Bd of Health Well Water Potability-Bd Health
!Permit from Conservation Commission
,- Z" a 110
Signature of u Date
NOTE:Issuanoe of zoning permit does not relieve an applioant's burden to oompty with ail
zoning requirements and obtain esii required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appiioabie permit granting authorities.
?o0.� O "•e City of Northampton REQUIRED INSPECONS
TI
BUILDING DEPARTMENT �' Footings and Walls
. Structural Components in Place
3. Complete Building*
No. 518 Office of the Building Inspector
Zoning Form No. Date 6/16/97 Fee $20.00 Check# Money order
Page, 17A Parcel 247 ,Zone URB Section 127 ❑ Yes ® No
BUI]LDINGPERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Scott Paquette before Building Inspections
has permission to strip & reshingle roof Inspection on Site—Foundations
situated on 96 Lake St - Armand Lafleur 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 T P ISES
Certificate of Occupancy
� Building Inspector