17C-264 (2) T
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r� Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. / �� Alterations
NORTHAMPTON, MASS.
7 //7/ 19-22 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location y ( A/, Ma t" - %`'��F✓^le.N c o Lot No.
2. Owner's name CAet y 1-e-r 4�a.,I rc Address
3. Builder's name 4114vj Address
Mass.Construction Supervisor's License No. �s"s'9o''� Expiration Date G &cp/gr
4. Addition 1
5. Alteration :r;n���l/����I Q?a 1 aC r M e.,.�" ws�lo�naKj' r I
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- 317 96 •00
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature oje7esponstble app ican!
Remarks
O�-(liMl PLO
CritLy of Wart1jampfon
9 ..,
{� �rssxchnsclta
A 8W7 DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street Municipal Building '
IF
Northampton, Mass. 01060 y '+
W0R RICER'S COMPENSA'zION INSURANCE AFFIDAVIT
V, "yo ✓�
(li�ns�/permi tlrc)
with a principal place of business/resideoce at:
r I at� �!! __ C(/i//�aw�s�wvd (phone;f) e Lr- 738'9
(strr...t/ci t}'/stalrJ�p)
do hereby certify, u-oder the pains and penalties of perjury, Lhai:
( ) I am an employer providing the fr)llo\v11)g worker's compensation cove:-age for my
employees woridng on this job.
(Insurance Catparry) (Policy Number) (Expiration Date)
(�C I am a sole proprietor, neral contractor or homeowner (circle one) and have hired
the contractors e ow who have the following worker's compensation policies:
(Name of Contractor) Qmsu=c-- Cornpany/Policy Number) (Expiration Date)
(Name of Contractor) (Insvr&nc_- CompauyiPoLcy Number) (Expiration Date)
(Name of Contractor) (Lnsurincz- Compauy/Policy Nambzr) (Expiration Date)
(Name of Contractor) (Insurancz Company/Poky Number) (Expiration Date)
(2112'11 additioml rhcct if noaers to iDr 3de iafixmi:ioa pertatmng to e.11 oodrnc:on)
(X=amma prop rietor and have no one worl=ng for me
( ) X am a.home owner performing all the work myself.
NOTE:please be awl chit wbilo bomcowocrs wbo employ pc=m to do m im-3wc eoasm)cdoo-or rtpaa Work on■d-Tiling of
not moce than throo uaits in which the bomoowncr rcudcs oc ca the grounds xpptutcasnt tbctcto arc oc(gcocrvlty eoandcmd to be
employers under tba woekc o=P=i4ca Act(GL152,=1(5))�aWdradoa by n homeowner far a liana oe permit may evidence the
legs!eta2un of an caployee under tho Wort .Compom.ation Act
[undersuad th2i a Dopy of this ealcmcut m.y be forwarded w tho Depvtmcnt of In�sri el Aoeidmb'CKSe»of Imuc.noe for tibe
coverage va ificsfioa and that fIBMIc to scorn covcnTo under socdoa 25A of MOL 152=cud to tbd imp�oa of-imins!pcaalb-
coasi3=&of a-fine bf up to S1,500.00 MON-impr000mcot of up to one year and civil p=46cs in the form of n Stop Work Order nod a
5m 0(5100.00 a day tpiwt tae.
Signed this / 7 day of �� 1997 Fa dep %1 taro only
Pe(�rmit Number Lot Jf
Signahtre of Lieeasce/Pe t�
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.
This aoluma 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 parkingN
# of Parking spaces
f of Loading Docks
Fill:
(vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
G, is true and accurate to the best of my knowledge.
kD?II"E= 7/r-? ! 9 '� '`APPLICANT's
SIGNATURE—NOTE: Issuanoe of a zoning permit does not relieve an applicant's bu nden to comply with,.rpll
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appiioable permit granting authorities.
FILE #
`\� ,� m,a
JUL 1 8W
} File No. J� i
ZOITING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: �b{�wo1 A� c lrfVl�nsb✓�
Address: Al-L-( Arra dQ _ Telephone: aG 8
2. Owner of Property: CAA,-1 ,es A(n u b
Address: 94i►n f rP%A Telephone:
3. Status of Applicant: Owner ntract Purchaser Lessee
Other(explain):
>< 4. Job Location: 5�!J!� ,y! !�
Parcel Id: Zoning Map# �7�� Parcel# a S� District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property Aa'e.,-4 ="
.� 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
-:17n j4b/1 :�� / yr .�► R-ed l a c.� m-e.,.�- �.t:.,oar,, �c
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 t "- � 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? N0_1eff 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)
13 S
FILE # 962559
J& 8
1997
DEPT OF pi
0 TACT PERSON:
ADORES
L
PROPERTY LOCATION:
MAP l7C' PARCEL: �p ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLO-SED REQUIRED DATE
ZONING FORM FT LED OUT
Fee Pairs
Builfiin2 Permit Filled mit
FPP Pair] / () —
TvnA of Conctn►rtion-
Arc"-nr!4 Structure
4
3 Set-, of Plans / Pint Plan
THE LOWING 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
_-Permul.from Conservation mission
Signature of Building h4rior Date
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all
zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commission, department of Public Works and other applicable permit granting authoritles.
City Northampton TIof REQUIRED INSPECTIONS
. BUILDING DEPARTMENT 1. Footings and Walls
2. Structural Components in Place*
3. Complete Building*
No. 675 Office of the Building Inspector
Zoning Form No. 962559 Date 7/21/97 Fee$20.00 Check# 150
Page, 17C parcel 264 ,Zone URB Section 127 ❑ Yes 0 No
BUI]LDING PERTVHT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT David Johnson before Building Inspections
has permission to install replacement windows Inspection on Site—Foundations
situated on 94 North Main St - Florence - Charles Handschuh Inspection of Plumbing—Rough
provided that the person accepting this pen-nit 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 MISES
_Certificate of Occupancy
Building Inspector
City. � of Northampton REQUIRED INSPECTONS
. BUILDING DEPARTMENT I. Footings and Walls
2. Structural Components in Place*
3. Complete Building*
No. 675 Office of the Building Inspector
Zoning Form No. 962559 Date.7/21/97 Fee$20.00 Check# 150
Page, 17C Parcel 264 Zone URB Section 127 ❑ Yes 0 No
BUIL, DING PERI'.
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT David Johnson before Building Inspections
has permission to install replacement windows Inspection on Site—Foundations
situated on 94 North Main St - Florence - Charles Handschuh 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, Inspea•.tion 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 Inspe,lion 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 p-��.
** Install per Manufacturer's information: windows,vinyl siding,roofs
Smoke Detectors(Fire Department)
and woodstoves
Other
THIS CARD MUST BE DISPLA D CONSPICUOUS PLACE ON MISES
Certificate of Occupancy
Building Inspector