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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.
C� Alterations
NORTHAMPTON, MASS. > � �� f 19 ,% Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location �°�tti Cr'mac' e1oc^n o? j \V r�1� n �� � � Z: Lot No.
2. Owner's name e--cl a ' ` Address
3. Builder's name c Address Lh Q3 sr. �+ r
�
Mass.Construction Supervisor's License No. d `�(L U Expiration Date c
4. Addition
5. Alteration
6. New Porch
?. 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 S),:�t_2
12. Type of roof
13. Siding house
14. Estimated cost
The undersigned certifies that the above statements are we o the best of his, her
knowledge and belief.
ltl��
Signature of responsible appicant
Remarks
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DEPARTMENT OF BUILDWG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
Scott Harlow DBA Harlow Builders
(1lcensctJpernuuee)
with a principal place of business/residence at:
350 Coles Meadow Road Northampton Ma (phone#) 586-0465
(stre-Ucity/sta&2ip)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worktel's compensation coverage for my
employees working on this job: !
Eastern Casualty Ins WCP0029365 8/24/9$
(Insurance Company) (Policy Number) (Expiration Dale)
( ) 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) Gm a=c-- Company/PoLicy Number) (Expiration Daze)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(anach additional sheet ifneoeaary to include mfocrosrion pert caning to all ooalrad )
( ) 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 cmplay pcaons to do,,aiat_ �coasuvction or repair work on a dwelling of
not more than Huse units is which the homeowner midi or m tha grounds appurteasutthatto ace not Cenemlly—ider ed to be
employern under the worker's c=Pcns4oa Act(GL152,ss 1(5)),application by a homeowner far a lioemc or permit may evideaoe tho
legal d-, of an employoc underthe Wodtoea Compenatioa Act
I understand dirt a copy of this statement may be forwarded to tho Depart nccd of Industrial A=:dm&Offloe of Insrusnoe for the
coverage vrsi icatioa sad that failure to scsure ooverago under section 25A of MGL 152 can lead to the imposition of crimi W pcaalti-
com�of a fine of up to S1,500.00 and/or*risoa of up to one year and civil penalties in the form of a Stop Work Order and a
firm of 5100.00 a day agnimt tae
Signed this _day of 1997 For depxxtntmtal use only
Permit Number
Maps Lot#
Siguahrre of Liccnsee/Permidee
�AND(nJcS.� yl x `f
L� too 1.65
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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 COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
Thia ccl== to be Pilled is
by the Banding Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L: R: L: R:
- rear
Building height
Bldg Square footage cV�,
%Open Space:
(Lot area minus bldg
' &paved parking)
# of Parking Spaces C-
7 cwr.
f rof Loading Docks
Fill:
volume -& location) j\ c�
13 . Certification: I hereby certify that the information contained herein
.1
is true and accurate to the best of my knowledge.
DATE: ZL
(7 APPLICANT'S SIGNATURE ��
NOTE: Issu no® of a zoning permit does not relieve an applioa wltl*,.nta burden o oomply +pill
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioabla permit granting authorities.
FILE #
File No.��
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: c�s
Address: t� � a.Y� Telephone:
2. Owner of Property: C`' l��^ �� � CS
Address: Telephone: S� (4
3. Status of Applicant: Owner Y Contract Purchaser Lessee
Other(explain):
4. Job Location: �9 42A-Ic- 2&z-zt
Parcel Id: Zoning Map# t Parcel# 3 District(s):_��i/LXJ T
(TOIBE IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed UseNVork/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 SpecialPermit/Variance/Finding ever been issued for/on the site?
�
NO V er 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)
FILE
O
APPLICANT/CONTACT PERSON:
ADDRESS/PHONE:
PROPERTY LOCATION: _ �P
MAP �1 PARCEL:- 5--- ZONE__
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FH,T,FD OUT
Fee Paid
Rnildin2 Permit Filled mit
Remndeling Interior
�t1'- ✓
r '
THE KLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
Approved as presentedfbased 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
Pe ro nse fa ' ❑
Signature of Building kislector Date
NOTE:Issuanoa of a zoning permit does not relieve an applioanvo burden to oompty with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
so City of Northampton REQUIRED INSPECTIONS
BUILDING DEPARTMENT 2. Strucctugral and Walls
Components in Place*
3. Complete Building*
No. 885 Office of the Building Inspector
Zoning Form No. 962789 Date 9/18/97 Fee $40.00 Check# 2113
Page, 17C Parcel 253 ,Zone URB Section 127 ❑ Yes No
BUI]LDINGPERM] f
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Harlow Builders before Building Inspections
has permission to replace existing wood fire excape with steel Inspection on Site—Foundations
situated on 29 North Main St - May Herochik 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 PL SES
Certificate of Occupancy
Building Inspector
4-
"�!qt..
C*ty of Northampton REQUIRED I TECUONS
1. Footings and`.galls
BUILDING DEPARTMENT 2. Structural Con.,ponents in Place*
3. Complete Builc dng*
No. 885 011ice of the Building Inspector
Zoning Form No. 962789 Date 9/18/97 Fee $40.00 Check # 2113
Page, 17C Parcel 253 ,Zone URB
Section 127 ❑ Yes No
BUH-jDING PERMIT
*Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Harlow Builders before Building Inspections t
has permission to replace existing wood fire excape with steel Inspection on Site—Fouahons G� ✓� �� i
situated on 29 North Main St - May Herochik Inspection of Plumbing—Rough
Inspection of Plumbing—Finish P rovided that the Pe rson accepting this pen-nit shall in every respect
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,
Maintenance and Inspection of Buildings in the City of Northampton. Inspection of Wiring—Rough ,
Any violation of any of the terms above noted is an immediate revocation Inspecti an of Wiring—Finish
of this permit.Expires six months from date of issuance,if not started. Building hispection—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.
Buildir g Inspection—Finish Gtr' 1 t-t q- f114"
Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAWD 1TjA CONSPICUOUS PL -E SES
Certificate of Occupancy --�-� , -�-t
Building Inspector