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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. A06• 12 19 Additions
Repair
APPLICATION FOR PERMIT TO ALTER
0"",
Garage
1. Location A%114 5T'e Lot No.
2. Owner's name �4�E}e/9�14�R Address F'%7-ff 70'/ /26 N0AYW4-#14P1—tr1
3. Builder's name --i C,- iA/k.,77W Address
Mass.Construction Supervisor's License No. O 5 Z 5 9/ Expiration Date o
4. Addition
5. Alteration Rros<' Jtv O'14 [)ppep,_92Qp ON C )r
6. New Porch
7. Is existing building to be demolished? A10
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof jZUB#9Fk Gook) PTU4 )207)P&A,
13. Siding house
14. Estimated cost:- 3060, c3o
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
'�--�(G�-� it • V V
Signature of responsible app icant
Remarks
O4K ttA 14 pT
4. AUG 1 9 "� of cwart 1 p to
9 d` �ass itch rticIIs
m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060 '
W0RICER'S COMPENSAITON INSURA-NCE A, t t AVTT
with a principal place of businesslresideoce at:
30 Lr!Jn/T—Y Av"JT'd-'�-7—co'q 94 (phone ') 667— aj' -3'5�
(StrezVcityistairinv)
do hereby certify, under me pains and penalties of perjury, ih?1.
O I am an employer providing the follo%vulg vrora�er's compensation cove:-age for my
employees woriang 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) QInsurancz, Company/Policy Number) (Expiration Date)
(Name of Contractor) (Lasurancz- Compa.uy[Podcy Number) (Expiration Due)
(Name of Contractor) (Insurance Compan�,Nobcy Numtxr) (E>,-piratio❑Da1c)
(Name of Contractor) (LnsZlranc--Company/Poky Number) (E)piration Date)
(cd.ich additioo�J c+ 1 ifnooca�ry to cxUdc ia(otmitioo pert_imng to all ooctr-._C.on)
I am a sole proprietor and have no one worl;sng for me.
( ) I am a-home owner performing all the work myself.
NOTE please be w;Lm that whilo bomcowo= hbo crxiploy Pcrsom to&�;TTI coa5tix:6oa-or rryair work w i ewtlling of
cot most thn tbroo t=its is whicft the bomoowncr raider cc ca the gourds xpputcnaat tbcccto en not gaxlvlly comidcrcd to be
employers under tbo work='s o=apcn ca Act(G L152Ss l(5)j applica0oa by a bomcow=for a liccwc cc permii may cvidcnoc the
ltgal ti-h, o£an employer undertho wO&k ,compomai Acc
t undcrAAOd dkxt z oopy of this ratcwmt may bo forwarded to the Dopwt�mt afln4us.rie1 Aecdma Offioo of Lx=A one for dh
oovaage vtxifiesiioo mad that fAilum to tcture eovango under seetioa 25A of MOL 152 an 1=4 to tbd imp�oa of-LMI tl pcaalacs
oomisuag of t fmc of up'to 51,500.00 sadfor ia� ofup to one year and civil pc=LWcs in the form of n Stop Work Ondcr and a
ficia of 5100.00 t dty against tnc
' Signed this tiay of (f(�(��j`r 1997 For dcpnrun�lu>o o If
Permit Numbcr
M2 p4 Lot#
Sipaab=of L.i0CnS=/PCrmiticc
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__710_
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUB TO
LACK OF INFORMATION.
This aol— to be Pilled in
hp the Building Department
Required
Existing Proposed By Zoning
Lot size
E
e
Frontage
Setbacks - frnnt
- 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:
(volume -& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
_1
DATE: C / APPLICANT's SIGNATURE om.. ,
�-,
NOTE: 1 n of a zoning permit does not relieve an applioant's burden to op%Aoi;,•$111
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applicable permit granting authorities.
FILE #
1
AUC3 1 91997
A
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: ---4Ci- W-A-704
Address: 130 �W LW �/7YcP _Telephone: 6 7 r 33 5
2. Owner of Property: -7VI'l AC.VA2-r16,i,
Address: L.Q.-�gv►1 ZoW /110 1p%d lh0 Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
?° _Other(explain): (DN
4. Job Location:
Parcel Id: Zoning Map# Parcel# District(s):
(TOD IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property jeF'571A4- JYf-
6. Description of Proposed UseANork/Project/Occupation: (Use additional sheets if necessary):
DUF' � GJ r r�4
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 M 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)
}.. 9 3 w J
FILE # C �3 � 1�
AUGAPPA ANT/C'`ONTACT PERSON: 4/n 7-
ADDRESS/PHONE: � O/4 G
- �
PROPERTY LOCATION: 97 n
MAP l ? PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM Eff LED OUT
Fee Pnid
Building Permit Filled mif
Fee PA ill
Addition to Fyi-.ting
f!j ✓
T LLOWING 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
I/
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
lPermit from Coat' o
Signature of Building ffivo&or D e
NOTE: Issuanoe of a 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 Pubiio Works and other applioable permit granting authorities.
ww
City of Northampton REQUIRED INSPECTIONS
. 1. Footings and Walls
BUILDING DEPARTMENT
2. Structural Components in Place*
3. Complete Building*
No. 790 Office of the Building Inspector
Zoning Form No. 962675 Date 8/20/97 Fee $40.00 Check# 1461
Page, 17C Parcel 214 ,Zone GB Section 127 ❑ Yes 0 No
BUI]LDING PERTVHT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Jack Walton before Building Inspections
has permission to reroof w/rolled roof existing layer w/rubber Inspection on Site—Foundations
situated on 99 Main St - Florence - Alexander's 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
Smoke Detectors(Fire Department)
and woodstoves
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON TKE PJUMISES
Certificate of Occupancy /e�-/:
Building Inspector