17C-211 (23) I�
rn
�€ C'_� .. -� Z n
R1L �
Z p
r v 0
a
rfl
Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. ���'-t` Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location Ul e Y?e e- so,-j: 7,a- if a�1 �� AfA,i in JLot No.
2. Owner's name Address �� �t ? `1 • Y '!�r_"1'?j' , / t pt
3. Builder's name !�. * f��� �S � C r!� Address i_ • %.} 1.' /;-/� G %t 'r i��lf !l/'
Mass.Construction Supervisor's License No. C 11-271 Expiration Date �l 14 P 1,ci
4. Addition
5. Alteration
6. New Porch
7. Is existing building to be demolished?
8. Repair after the fire fu C'
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines /1 /
12. Type of roof
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.//�,--?
Signature o r po i e app,icanl
Remarks
�0 ` 0� atf� af Nartl7aillpton .
a
a i
Axis itch
n'tittt
DEPARTMENT OF BUILDEgG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORICER'S CONMENSAITON INSURANCE A t t AVIT
(1i perwittc.--)
vvith a principal place of busGess/residenc,, at
do hereby certLrj,, uj3der ifie pa-m and pcoalties of perjury, Lh2i:
l✓J r �-;m an employer proving rile following v,,or"-&S compensation cove age for rm_,
employees worlang on tliis)&
(I.nsurancc Compaay) (Pohc-y 1\umbc1) (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:
(Nnmc of Contractor) (Lasuranc-- Comparry/Pok—f Num cT) (Expiration Datc)
(Name of ContTP CIO r) (Innr anc Comp ylPoGcy tlus�csr) (Exxpira6on Date)
(N=c of ConL�ctor) (tasu-anc:-- Compam,lpolicy Ntunhl-r) (Eip ra000 D2ic)
(Name of Contractor) jaalranco Company/Polief Numtrr) (Expiration Datc)
(�.'LU-�iCditioml cbnd iloccc-wry co c.=.5ck�z.�cYmi�co p.-;r�r�n�to X17 ccc:r_c'_on)
O I am a sole proprietor and have no one wor4-ng for me.
( ) I am a home owner performing all the work myself.
NOT£,please be a rUC cLui whi]o 6 cxrnrkn.tit o employ pctom w duct oo'or rcpt r wor oo dµcll ny of
cwt more th_u Lbroo uniu is wEncti tb< (x ea Lb- or� g�ewncicrcd to be
"ploy- appt aEon lry i hocvowo r far a licrnx c<pern i „y v cc the
Iep�!rtxhia of as e=,pioy,undertt-Wo <c!r com�,k,
I und<rsund chit a Copy of th"." �m.y bo focv.nfd<d to tbo Dcpormrat of 1n�Sir i cl.loadcatf Off—oI L—for cbo
wvcsxge vetificszio0 and that fiiltuc to teauc wvccabo under s�tioa 2SA of MOL 112 cw lu d t4 tbo'impaziboo oCeiiminil petulties `-
waiutYng or a-fine brup to S I-500.00 n"or imprvoomcnt 0(up to oa yrrr and avil p u.1t o in[be Co m oC a Stop W orC Order and i
find 0(5100.00 S.dray apli .tom
S t gn cd c, day of /,)tit ' 1997 For droatm� �t,—only
Permit Number
Mai! Lot V
Si of LiocnscclI' .
Do any signs eDdst 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, descrbe size, type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This colmX to ba filled in
by the Bnildinq Dcpartment
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - front
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
of -Parking Spaces
of Loading Docks
Fill.:
'4vol-ume--& .location)
13 . Certification: I hereby certify that the information contained herein
4 is true and accurate to the best of my knowledge,,.,
DAVE: '� APPLICANT's SIGNATURE
NOTE: [ssuanoe ad a zoning permit does not relieve nn appi Dents bu @ oomp[y with all
xoning rc>qu[rementu and obtain all required permlta from the Board o! alth, Conservation
Commission, Department of Publio Works and other applloable permit granting authorities.
FILE #
R ,
i
i
AUG 2 91997 File No.
,ZONING PERMIT APPLICATION (§10 . 2)
'`PLEASE =,E3 OR PRINT ALL =FORMA=ON
/� �/
1. Name of Applicant: U" )0tfV-k 1` d[r) .t;
c, _
Address: ' `3i j j�L(2/n� �� fj Telephone:
2. Owner of Property: ���j'�?i'�1�(1 /Fly
Address: �6 A-41 ;T /J?J�'l'I � /�J , Telephone: ✓? (p ' t%
3. Status of Applicant: Owner Contract Purchaser Lessee
k Other(explain): 0 00 �-a �eQ
4. Job Location: � 1�1�� }'- ��;Y 'l (�-
J
Parcel Id: Zoning Map# Parcel# / District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/P rope rty
6. Description of Proposed Use/Work/Project/Occupadon: (Use additional sheets if necessary):
'^" _a (�1� 1�1-y ✓4_ l T i_!_' J
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 DONT 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)
FILE
y
AUG 2 9199
APPLICANT/CONTACT PE
6
C
PROPERTY LOCATION:
MAP "7�. PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM EH,1 ED OUT
Fee PAid
]Riiil in2 Permit Filled nut
Fee Paid
Rernridplin2 Interior
Addition to Existing
T OLLOWING 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
!Permit from Conservat' Co}nuyis ' n
Signature of Building for Date
NOTE: Issuanoa of a zoning permit does not relieve an applloant's burden to comply with all
zoning raquirementa and obtain all required permits from the Board of Health, Conservation
Commlaslon. Department of Public Works and other applioable permit granting authorities.
���� City p TI of Northam ton REQUIRED INSPECONS
. BUILDING DEPARTMENT
I. SaUccttu al and Walls
Components in Place*
3. Complete Building*
No 823 Office of the Building Inspector
Zoning Form No. 962722
Date 9/2/97 Fee $100.00 Check# 5585
Page, 17C Parcel 211 ,Zone GB Section 127 ❑ Yes ® No
BUILDINGPERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Young Roofing Co Inc before Building Inspections
has permission to install new carlisle membrane roof Inspection on Site—Foundations
situated on 85 Main St - Florence; - Florence Savings Bank 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 pen-nit.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 ISES
Certificate of Occupancy
` Building Inspector