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17C-258 (9) > z < n� Z m ac 70 in Z a 3 � o 0 o � A Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MASS. X)oV 19 7,> Additions APPLICATION FOR PERMIT TO ALTER Repair / Garage 1. Location Lot No. 2. Owner's name Address S,Z�n't--Q— 3. Builder's name t�0i�t'S�a� j Address q S/ Mass.Construction Supervisor's License No. La7y.s Expiration Date—'Z--D 2 cr, 4. Addition 5. Alteration 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 ' The undersigned certifies that the above statements are we to the best of his, her knowledge and belief. Signature of responsible app,icant Remarks zit/S��i�// lJi�✓J 1 �C �,i /�/.. %�- l./S 61997� �, �V �lastsxcEinscttts m DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 'J WORKER'S COMPENSATION INSURANCE AFFIDAVIT (li con der/permi tt ee} with a principal place of business/residence at: (phonelo (s tmet/ci ty/stat e/a p) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: a surance 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) (Expirntion Date) (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) (attach additioml dhoti if neoessary to include informaIIoa pestaiuing to all omtr' ors) ('\�/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 homeownen wuo employ persons to do maizAccA^n cor sanction or repair work on a dwelling of not mote than throe units m which the homeowner resides or on the grounds appurtenant thacto are not generally oowukrcd to be employers under the vmcke's o=:pcas4oa Act(GL152,ss 1(5)),application by a homeowner for a lictme or permit may cvtdcace the legal status of an employer under the Workeea Compensation Act I undaatAnd that a copy of this ctatemcut may be forwarded to the DepartmmQ of IndsLdrial Aca&=&Oflioe of Iuauaaos for the coverage verification and that failure to secure coverago under section 25A of MOL 152 can lead to the imposition of criminal Pcnaltiea oornis>zn g of a fine of up to S1,500.00 and/or imprtso>mxnt of up to one year and civil penalties in the form of a Stop Work Order and a find of 3100.00 a day tgainst ma Signed this � _day of A/O k1 1997 FCC departmental use only Permit Number �� Map#_ Lot# Signature of Liccnsee/Permittee 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 cclu= to be filled in by the building Depnrtaannt I (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 parking) # of _Parking spaces # 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. DATE: APPLICANT's Sl'GNATURE l NOTE: Issuance of a zoning permit does not relieve an applioanYs burden to oompty Wit4'4111 zoning requirements and obtain all required permits from the Board of Health, Conservotion Commission, Department of Publio Works and other applicable permit granting authorities. FILE # NOV 61997 File No. ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: Address: G� Sf Telephone: �l 2. Owner of Property: I-"l�� Address: �� �I/O�'�� /� ��� S-7 �"� Telephone: 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): 4. Job Location: Sl4n�e� Parcel Id: Zoning Map# Parcel# + District(s): O BE FILLED IN BY THE BUILDING DEPARTMENT) r 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/Vadance/Finding ever been issued for/on the site? NO DON'T KN01W ✓ 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) n i FILE # 9 r 5 9 ! 1677 NOV 61997 APPLICANT/CONTACT PERSO W ADDRESS/PHONE: PROPERTY LOCATION: GLZC�L, 'c�C MAP f JC-, PARCEL: ©?fir ZO THIS SECTION FOR-OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM MIND OUT Fee PAid -Fee pnifi c/ &6) Q rG THE ,FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION: L/ 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 Conservatio ommission 9� ure o i p r Date Signat NOTE: lssuanoa of a zoning permit doer not relieve an applioant's burden to oompty with all zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Department of Publio Works and other applioable permit granting authorttles. Cit y of Northampton REQUIRED INSPECTIONS i 1. Footin s and Walls BUILDING DEPARTMENT 2. Structural Components in Place* 3. Complete Building* No. 1077 Office of the Building Inspector Zoning Form No. 962997 Date 11/7/97 Fee $20.00 Check# 2460 Page, 17C Parcel 258 ,Zone URB Section 127 ❑ Yes ® No BUI]LDING PERMIT * Plumbing and Electrical Inspections required THIS CERTIFIES THAT Ed Corbett Jr before Building Inspections has permission to install replacement windows Inspection on Site—Foundations situated on 58 North Main St - Roy Frost 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 TW PREMISES ` Certificate of Occupancy Building Inspector