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32A-195 (6) T � cn Z I � > _ y Z 41 --1 ^' 70 r � C O v � Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. - 7 - 22 6 Alterations NORTHAMPTON, MASS. ��r 191 Additions ' APPLICATION FOR PERMIT TO ALTER Repair Garage 1. Location ` <<i (� S f��'I 4 Lot No. 2. Owner's name l lh'i S 1 u^-r-v Address 1{J { C .4J I P L 3. Buildei s name Address i 1 G7 Mass.Construction Supervisor's License No. U 1 3 \c] Expiration Date //�!y i f 9 4. Addition 5. Alteration /c = /�� i //6s <<�• 6. New Porch 7. Is existing building to be demolished? 8. Repair after the fire XV�= 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:- The undersigned certifies that the above statements are true to the best of his, her knowledge and belief. i nature of responsible app icon! Remarks $ NAY 1 4, 199 i Grits of &NOrt amptan .�IASaAChtt8ttl4 DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT L © pis 760 "',(--Y, (license&permittee) with a principal place of business/residence at: -�4 o is.a (phone#} -=, Z - z Z s (St=Ucity/sta&2ip) do hereby certify, under the pains and penalties of penury, 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/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Poticy Number) (Expiration Date) (attach additional shed if necessary to include information pertaining to all ooe xecxors) (/ 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 wWo homeowners who employ pasom to do maintenance,construction or repair work on a dwelling of not atom than three uaits is which the homeowner resides or on the grounds appurWnani thereto are not generally 000sidend to be employers under the worker"s oompcnsatim Act(GL152,ss l(5)),application by a homeowner fora license or permit may evidence the legal statue of an employer under the WorlCds Compensation Ad. I understand that a copy of this uatemeut may be forwarded to the Depnrtrn o of Iodrutnal Aeed&U&offioe of Imru wa for the coverage verification and that failure to secure coverages under section 25A of MGL 152 can lead to the imposition of criminal penalties consisting of a fine of up to$1,500.00 and/or imprison of up to one year and civil penalties in the form of a Stop Wale Order and a firm of 3100.00 a day against mj t:. /yam Signed this 'd Ua�day of )y ` 1997 For dqmtarntd use only _� --- Permit Number Mao Lot# Si tcensee'Permittee 1 i ` k u 1661 V 1 �I INt 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 COMPLE'T'ED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. This columa to be filled in by the Building Department Required Existing Proposed By Zoning Lot size Frontage Setbacks - frnnt - side L: R: L: R: - rear Building height Bldg Square footage %Open Space: (Lot area minus bldg ' &paged parking) o f -Parking Spaces f fof 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: lstsisanoA of a zoning permit does not relieve an applio burden to oompty wlthlr all zoning requirements and obtain all required permits from t " Board of Health, Conservation Commisslon, Department of Publio Works and other applioabla permit granting authorities. FILE # MAY 1 4199, _ a• Fi 1 e No.-- ZONING PERMIT APPLICATION (§10 . 2 PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: �o C//3 �—a�'� Address: /l 1 �`<'�' ti �! `'Z`� �i �.f Y`0/z) T?ephone: s Z? Z z _3 2. Owner of Property: /` s his%. •• Address: Z PL. Telephone: 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): 4. Job Location: Parcel Id: Zoning Map#,� Parcel# District(s): �� (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 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/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 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) ` 01 96 1� FILE # 124 3 MAY 1 4199 APP ICANT/CONTACT PERSON: D�GCeO :�Jc c�? a2� ADDRESS/PHONE: PROPERTY LOCATION: MAP PARCEL: _ ZONE �Z" THIS SECTION FOR_OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM MLED OUT 6-1 $ Y/ V THE,FOLLOWING 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 Coati o •5�9 Signature of Building awl6tor Date NOTE: Issuanoa of a zoning permit does not relieve an applicant'a burden to comply with all _ zoning raquiremants and obtain all required permits from the Board of Health, Conservation Commission, Department of Publio Works and other applicable permit granting authorities. i, I pro : City of Northampton REQUIRED INSPECTIONS 1. Footings and Walls BUILDING DEPARTMENT 2. Structural Components in Place* 3. Complete Building* Office of the Building Inspector NO. 393 Zoning Form No. 962243 Date 5/15/97 Fee $40.00 aleck# 367 Page, �7A Parcel 1 A5 ,Zone rrFzr Section 127 ❑ Yes 0 No BUI]LDINGPERMI r I I * Plumbing and Electrical Inspections required THIS CERTIFIES THAT Louis Montgomery before Building Inspections has permission to remodel bath Inspection on Site-Foundations situated on 24 Phillips Place - Nicholas Flynn 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 ISES Certificate of Occupancy ~ Building Inspector i