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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. y Vim'��1° Alterations
NORTHAMPTON, MASS. �— 19 1 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location ?/ El—' '€�^-�`�� Lot No.
2. Owner's name �CV�/v � �'fir? — Address Jc'
3. Builder's name'5���`' I�� /N 5lr/ Address f`L' F�L,, _ ti, ec C)
Mass.Construction Supervisor's License No. �`�"75'x-`i Expiration Date
1'T�"
4. Addition /'cx l'r to 2-t- r r �� /'�i -`4-,j n o'-c>a /J
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 -7 L f-p% 3Yr't'r''
12. Type of roof P/ J'TZH -
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
r
Signature of res,ns,b a app,icant
Remarks
31991
g� Crzt� of 'Wart4ailtptan
r t �IaSaarhmStlllF
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street a Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFEDAVIT
L 14' :�?- / /
(lic ensee/permittee)
with a principal place of business/residence at:
�a I-1 kA U i'VD 6 k 2 Z) , rw�i2������,���� (phone#)
(street/city/staW2:ip)
do hereby certify, under the pains and penalties of peljury, that:
i-5�'c./ y coo.s-_
0 I am an employer providing the following worker's compensation coverage for my
employees working on this job:
I p-4a a/,?a- � C' �s4-//8"iVY n., 9 3/17
(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 Date)
(Name of Contractor)
(Insurance Company/Policy Number)
(Expiration Date)
(attach additional sheet if necenary to include information pertaining to all oo m)
( ) 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 homeowners who employ persons to do maintenance,conaniction or repair work on a dwelling of
not more then thine units in which the homeowner resides or on the groin apputtenw thereto are not ge+awally considered to be
employms under the worker's c ompensatim Act(GL 152m 1(5)),application by a homeowner for a iicem or perm it may evidence the
legal status of an employer under the Worker's Compensation Ad.
I understand that a copy of this statement maybe forwarded to the Depaxtment of la Mistrial Accidents•Office of Insurance for the
coverage verification cad that failtmo to seatre coverages under section 25A of MOL 152 can lead to the imposition of criminal penalties
coctsistittg of a fine of ip to$1,500.00 andlot of up to one year and civil penalties in the form of a Stop Work order and a
Time of$100.00 a day against me.
Signed this day of :Ti 199 %
Si Licenseee/P— ze
For depra4mmtal use only
Permit Number
Mao Lot#
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10. Do any signs exist on the property? YES NO X
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 C01.== to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
S,;,fr 10/ 05-7
Frontage +"
Setbacks 3Y
- side L: '3 7 R: L: .2 7 R:
- rear
Building height i
Bldg Square footage 1 1 3 f s& rT, /S-(-/3 SL
%Open Space:
(Lot area minus bldg �� 7�/
' &paved parking)
# ,.pf Parking spaces
#`of Loading Docks
Z> G
Fill:
'4 voI-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 --
r,; NOTE: issu no of a zoning permit does not relieve an p ioant's b rd n to comply with .gtl-
zoning requirements and obtain all required permits f he Board.oi ealth, Conservation .s
Commission, Department of Publio Works and other applicable permit granting authorities::.
`. ;< FILE #
JM 1997
j File No 1
DEds
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR P=T ALL INFORMATION
1. Name of Applicant:
Address: �o c--)'CX I oCCU Telephone:
2. Owner of Property:
Address: ' Telephone:
3. Status of Applicant: Owner nn Contract Purchaser Lessee
Other(explain): Ro i i_uE-4?— )--y -r°r<
4. Job Location: vim? ✓fi�c c I
Parcel Id: Zoning Map# /J Parcel# _ District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property ��C.� r �• ��N c �� iy ' r��t_ Ct
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
--'6 ruy--`f TAG L 0,4 S j.� F- Cr 1.5 Dw,i
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 ->4 YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW 11-/ YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook,body of water or wetlands? NO K 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 # Q
31997
APPLICANT/C NTACT PERSON:
NORTH " ` .
PROPERTY LOCATION: 1,21 ryagke
MAP ! PARCEL: ZONLV
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM M,Y,FD OUT
Stmirture
�' L�, G ✓
2 THE LLOWING 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
Septic Approval-Bd of Health Well Water Potability-Bd Health
-�t fro o_n� on �)
Signature of Building Ing6ector ate
NOTE:Issuanoe of at zoning permit does not relieve an applioant's burden to oomply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
City of Northampton REQUIRED INSPECTIONS
e 1. Footings and Walls
BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
No. 475 Office of the Building Inspector
Zoning Form No. c)62336 Date 6/5/97 Fee $206.00 Check# 2296
Page, 17A Parcel 244 ,Zone URB Section 127 ❑ Yes ® No
BUI]LDINGPERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT John zieminski before Building Inspections
has permission to construct (2) room addition Inspection on Site—Foundations
situated on 82 Lake St - Joanne Katz/James Meyer 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
Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON PREMISES
Y
Certificate of Occupancy
Bui ding Inspector
C ofNorthampton REQUIRED INSPECTIds
y
e 1. Footings and Walls
BUILDINGDEPARTMENT 2. Structural Components in Place*
3. Complete Building*
No. 475 Office of the Building Inspector
Zoning Form No. 962336 Date 6/5/97 Fee $206.00 Check# 2296
Page, 17A parcel 244 ,Zone URB Section 127 ❑ Yes ® No
BUJILDING PERmi r
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT John Zieminski before Building Inspections
has permission to construct (2) room addition Inspection on Site—Foundations
situated on 82 Lake St - Joanne Katz/James Meyer 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, Inspxtion of Wiring—Rough 4
Maintenance and Inspection of Buildings in the City of Northampton.
Any violation of any of the terms above rooted is an immediate revocation Inspection of Wiring—Finish
of this permit.Expires six months from date of issuance,if not started. Budding Inspection—Rough
Note:A certificate of occupancy will be issued by this office upon return Insulation Inspection t - 7
of this card signed by the Plumbing,Wiring and Building Inspectors.
Building Inspection—Finish '�?7
Smoke Detectors(Fire Department)
Other
THIS CARD MUSTI,S A CONSPICUOUS PLACE ON PREMISES
Certificate of Occupancy 3r
Bu' ding Inspector