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17A-245 (6) > Z I � tr �/ n• T v a r° Ln Z > -� m _a Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. �f�� Alterations NORTHAMPTON, MASS. TA 14 ,7 - 19 Additions • Repair (� ' APPLICATION FOR PERMIT TO ALTER Garage 1. Location 4-,,,&,e 5f• Lot No. 2. Owner's name_ Q • E- e et`v � v-- Address 9" G k E- 3. Builder's name O�ae r Address L-p-ed S Mass.Construction Supervisor's License No. D;k/3 14 Expiration Date 4. Addition /y ( �+ 5. Alteration re 4Ve e Id •1' jdnC ;L f-a ja= w r �'1 A 1w 1 V-Y��r T44, b 6 I J Ad.��t k/A(( k Wee- tt4,,— 6. New Porch /f//4 7. Is existing building to be demolished? /t/© 8. Repair after the fire 9. Garage /V ►'` No.of cars Size 10. Method of heating 11. Distance to lot lines 12. Type of roof 13. Siding house A f v rr l n.y M 14. Estimated cost- -� d 0, The undersigned certifies that the above statements are true to the best of his, her knowledge and belief. Signature of responsible appicant Remarks �0�KT�, 81.99�T a e Crzf laf Nart1juniptan y 8 �t , +? �;T3"uN$ �xsaachacrlta m DEPARTMENT OF BVILDWG INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE + t AVIT (li censer/perms tics} with a principal place of business/residence at: 4I a —(Phone-") V)3,'-5 6St—W;;'c2 (strt/ci t)'/stairhi P) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the follo"ving Nvorker's compensation cove,ge for my employees working on this job: (Las-i=ce Company) (Policy Number) (Expiration Date) (.Jf I am sole proprietor general contractor or homeowner (circle one) and have hired the contractors list et w who have the following worker's compensation policies: (Name of Contractor) Qmstuance Company/PoLicy Numbcr) (Expiration Date) (Name of Contractor) (Insurance Companyi?oLicy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (enact additioml d—t if--Y to intrude iafbnmtioo pauimng to nil ooc[-'M t n) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:plea=be awsLm tbzt vibDo bomeovnxTr who employ pasom to do,,••:••e•,,= eomtrurtioa,or repair worse on a dwelling of not mote than tbroo units is which the bomoowncr rrsides or ca tbo grounds zppurtensni tbacto arc cot gc ocmIly eoandcrcd to be cmPloyvs under tbo work-".-mp=s icn Act(G Li 52.=1(5) appliraDoo by a bomcowocr for a liaosc cc permit may evid=cc the legal etab"of an employee uederdw Workcoes Compom,.tioa Act I uadcsund that a copy of this mtcmcnt may bo forwarded to tbo Dcpartmca of Indtitsinl Ac6d=&Of —ofl=xur o for dw coverage vcrificstioa and that failure to saute covcrago under socdoa 25A of MGL 152 an Iced to tbo'imposi -of crirninsl Prnaltica ooasismxg of a fine bf vp'to S 1,500.00®d/or imPr¢oamcnt oCtep to one ytxr and avil pcmLW is the form of a Stop W ork Orda and a fine of:S 100.00 a day against tae, Signed this r _day of ,)j 1997 Fo,d Iu..o'ay J Pcrmit Number L Map4 Lot# Si of I;ieensccJPcrmitece 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 --t== to be filled in by the Building Department 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) # of �Parking spaces . .-,'I - -J # 'of Loading Docks Fill: Avol-ume--& location) /VX 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. _1 DATE: 'J o? ,7 APPLICANT's SIGNATURE , NOTE: lssu'anoe4 of a zoning permit does not relieve an applloailrnra burden to oompfy wit4;4111- z9ning requirements and obtain all required permits from the Board of Health, Conservation Commission, Department of Publio Works and other applioable permit granting authorities. FILE # 7199�fi File No. , � F ' ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: 1 0 C e cl Address: Q'X -�y ('z = `cD C/aS Telephone: 2. Owner of Property: ID v b e Address: F( Z--k ke— Sf, Telephone: 3. Status of Applicant: Owner lr Contract Purchaser Lessee Other(explain): F6 4. Job Location: 6 LG�-'r Parcel Id: Zoning Map# ,/ Parcel# to District(s): (TO BE FILLED IN BY THE BUILDING DEPARTMEN 5. Existing Use of Structure/Property. rhc 6. Description of Proposed UseNVork/Project/Occupation: (Use additional sheets if necessary): r r w ' fi �e b o li�. 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_L 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 # tl APPLIC1 C NTACT PERSON: PROPERTY LOCATION: MAP PARCEL: ZO THIS SECTION FOR-OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM EMLED OITT Fee Pnid Rnilding Permit Filled mit Fee Pq if] '6 — Type of Crin-gtriTrtion- 11) r L i� THE >P1LLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION: I-"' 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 _P ' -fro onsegat' o lel Signature of Building inaoKctor NOTE:Issuanoe of,a,zoning permit does not relieve an appiloant's burden to comply with all zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Department of Publio Works and other applicable permit granting authorttles. 2 � NN lot Not "s Al" A WAYS „ m ti ,g c a .,. > ; x rr e x � i WON Wolcott A NOW, all -HAT Elk jindyff TY 41 ,r loon N r nk 1 WASP, Y k F.. 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