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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. e.",//---? I 92Z Additions
• ' APPLICATION FOR PERMIT TO ALTER Repair
_ Garage
1. Location �`D �f �'� Sj Lot No.
2. Owner's name ,L- L� rt-c� Nu 1°I4 t� Address AGe 1. _T
3. Builder's name ('-7w Address -5;d AP70CA .S'/
Mass.Construction Supervisor's License No. 540DD Expiration Date 7���-
4. Addition
5. Alteration t--P f-a r t /vq /rr A - Y C-l-
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:-
qdv�
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible app icant
Remarks
• � ,1UN � 6 199 t
9 Xassaciinsetts
;{ •-` DEP TMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
tf-- 1
(li lermia=)
with a principal place of business/residence at:
SG dim®&*- �/ e r_c_-1_, , Cohone#)
(st=UCity/stafe/ap)
do hereby certify, under the pains and penalties of pegury, 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/Poli(:;y Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Coa=ctor) (Insurance Company/Poticy Nurnbel) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additiooal shed ifnoocauy to ioehsde infwnuhoo pertaining w ell 000tmaorn)
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 whilo homcov,,um who employ pawns to do mxjnj •nm coastrucuou or repair work on a dwelling of
not moco than throe units is which the homeowner raider or on the grounds appurtena thereto are not generally ooandcrcd to be
employes under the wodccrs oration Act(GL152,ss 1(5)),application by a hom owar for a license or permit may wide=the
lea2l stvbn of an employer under the Worka's Compecs&tion Act
I undastsnd that a copy of this rEat--rt may be forwarded to tho Dcpactnx of Indus:rie!Accident,'Office of laviraoco for rho
coverage vaification and that fad=to Satre coverage under sectioa 25A of MOL 152 can lead to the imposition of a"immal penalties
oomisting of a fine of up to 51,300.00 and/or imprao�of up to one year and civil penaitics in the form of a Stop Work Order and a
firm of 5100.00 a day against mc"
Signed this " day Of I 1J(--r- _.x.199 7 For dcpuaamtnl—only
Permit Number
Map# Lot#
lure of Li crrn.ittce
10. Do any signs exist on the property? YES NO S� ,
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.
Thi.= colma 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 of Loading Docks
Fill:
-(vol-time--& 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: Iss anoe of a zoning permit does not relieve a Iioant' burden to oom wit
P P7Y Fr,..al1
zoning requirements and obtain all required perms m the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities:..
`v ',r FILE #
.�11d 1 61997
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE- TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: � o—L f ;Y
Address: kyy1 oc-tc- �S f Telephone: —'�f S—�4 ?
2. Owner of Property: i9ejV.KC"e"l y
� k
Address: C �I 0101 L7 _Sf Telephone: 'S--y
3. Status of Applicant: Owner _Contract Purchaser Lessee
Other(explainl:
4. Job Location: �d t 4Li S�
Parcel Id: Zoning Map# %�.. Parcel# IJ-6 District(,,a
(TO BE FILLED IN BY THE H/BUILDING DEPARTMENT)
5. Existing Use of Structure/Property AeLlS e- dl-<_i
6. Description of Proposed Use/Work/Project/Occupabon: (Use additional sheets if necessary):
e. ra car iAu -
\5Jr7 a l 4,9,xig=
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 PermitNadance/Finding ever been issued for/on the site?
NO DON'T KNIODW 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)
it FILE # tUV J
61997 1
APPLICANT/CONTACT PE N:
ADDRESS/PHONE:
PROPERTY LOCATION: C) �-� --
MAP / 7C- PARCEL: l` (p ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FH,T,FD 01IT
Fee Paid
13iii1ding Permit Filled 011t
orFee Pnid
c�v
TBE,P61,LOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION- <
Approved as presented/based on information presented
r
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 Conservatio ommission
l
Signature o Bui g r Date
NOTE:issuanoe 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 Pubiio Works and other applicable permit granting authorltles.
t�N
City of Northampton REQUIRED INSPECTIONS
BALDINGDEPARTMENT 1. Footings and Walls 2. Structural Components in Place*
3. Complete Building*
No. 535 Office of the Building Inspector
Zoning Form No. 962408 Date 6 17/97 Fee$20.00 Check## 894
Page, 17C Parcel 156 ,Zone URB Section 127 ❑ Yes 0 No
BUI]LDING PERTVHT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT John Corbett before Building Inspections
has permission to strip & reshingle roof Inspection on Site—Foundations
situated on 80 High St — Elaine Bonneau 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 D
k
Smoe Detectors
(Fire Department)
and woodstoves
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON PREMISES
Certificate of Occupancy
Building Inspector