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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. °-� Alterations
NORTHAMPTON, MASS. 19 Additions
' APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location— / L � j Lot No.
2. Owner's name �f�G �'F Address 7 Li G L/ t\. �-C�
3. Builder's name�.f S/�C,DlitO P,L � `i/LfFL( �+�J?:Address 7 aP-/ 6 6
Mass.Construction Supervisor's License No. Q 6 4- �,-) 6 Expiration Date ��zc�Z 9 X
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 &1111 L F C c1 t.II 17 h'-6)z
13. Siding house
14. Estimated cosL-
1 J G The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Sig tune of responsible app,icont
Remarks k F,A1061=
Crzt� of &Xort amptott
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$ � n �7 � � �Iassaclinsctfs
7
DEPARTMENT OF BUILDING INSPECTIONS
r
DEPT Of BUILDMG INSPECTIO4,", 212 Main Street a Municipal Building '
Northampton, Mass. 01060
WORKEWS COMPENSATION INSURANCE AFFIDAVIT
L AIL'SIt`e IrliLa
(licenserJpermittee)
with a principal place of business/residence at:
1 Z f-01
(street/city/state/zip)
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 worlang 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 workers 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/Policy Number) (Expiration Date)
(attach additional sheet if necessuy to include infbnnstion pabkining to all ooh actors)
eam a sole proprietor and have no one worldng for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that while homeowners who employ persons to do maidmance,construction or repair work on a dwelling of
not more than throe units m which ttia homeowner resides or on the grnuadt apprutaasni tbereto art not generally considered to be
employers under the worker's compensation Act(01,152sa1(5)),application by a homeowner for a license or permit may evidence the
legal status of an employer under the Wot wee,Compensation Act.
I understand that a copy of this atatemad may be forwardsd to the Deparumn,of Industrial Amdants•offioe of Insurance for the
oovexage verification and that failure to secure coverage under section 25A of MOIL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to$1,500.00 suitor imprisonment of up to one year and civil penalties in the form of a Stop Work order and a
ftno of$100.00 a day aping tot
Signed this� day of 1997 For departmental use only
Permit Number
Map# Lot#
Signature of LicenseetPerkittee \ /
See reverse side for in%Mtctinnv
ry 4
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 cols to be filled in
by the Buildimg 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 parking)
# of -Parking Spaces
f of 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.
_1
DA'Z'E: APPLICANT`s SIGNATURE
?" NOTE: 1 ua oe f a zoning permit does not relieve an applicants
rden to oom ly wit
9 P P. f1t,•all
zoning uiremants and obtain all required permits from the BoarU of Health. Conservation
Commission. Department of Publio Works and other appiionble permit granting authorities.
FILE if
`
JUN 90
`
T 60 File No'
��� �� � �
����um�� PERMIT �����������" x ��� ° ��
PLEASE TYPE OR PRXNT ALL INFORMATION
1. Name of Applicant:
-
Add
_. ----' of Property:
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: 17 &Q- V
Parcel Id: ZoningyNop Parcel# j District(s):
(TDBE FILLED |NBY THE BUILDING DEPARTMENT)
5. Existing Use ofStructure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
7. Attached Plans: Sketch Plan Site Plan nQinemrod/GurvmyedP|ons
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
O. Has a Special Pennib/Vohonoe/Findi 7YES uedhnnhnthe o�e?
N DON'T KNOW {F YES,date issued:
lFYES: Was the permit recorded at the Registry nfDeeds?
NO DON'T KNOW YE
IF YES: enter Boo d/o ocunnand
9' Does the s�econtain a brook, body of water orweUando? N DON'T KNOW YES
IF YES,has a permit been or need to be obtained from the Conservation Commission?
Needs tobe obtained Obtaineddate issued:
'
(FORM CONTINUES QNOTHER SIDE)
'
.�.. _ FILE
JUN 9199 f ,�
T,.CT PERSON: �1 1. D� .5d —017 Q
PROPERTY LOCATION: -�
MAP PARCEL: `7 ZONES,: r
THIS SECTION FOR-OFFICIAL USE ONLY:
PERWr APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
113nilding Permit Filled nilt
-2o
Type of Constmirtion'
Now Cnnqtrjirtinn
Included-
Owner/ 3o 4,
3 Sets of Plans /Plot Pinn
THE LLOWING 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
!Permit om Conserva io m is
Signature of Building Insp r ate
NOTE:lasunnoe of as zoning permit does not relieve an applioant'a burden to oompty with all
_ zoning requirements and obtain all required permits from the Board of Health, Conservation
Commlasion, Department of Publio Works and other applicable permit granting muthorltles.
City of Northampton REQUIRED INSPECTIONS
} , BUILDING DEPARTMENT 1. Footings and Walls
2. Structural Components in Place*
3. Complete Building*
No. 520 Office of the Building Inspector
Zoning Form No. 962370 Date 6/16/97 Fee$20.00 Check# 816
Page, 17C Parcel 276–,Zone URB Section 127 ❑ Yes No
BUI]LDINGPERNUT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT D E Shepard before Building Inspections
has permission to remvoe tin roof & isntall double coverage Inspection on Site—Foundations
situated on 17 Lilly St — Daniel/Lori Cahillane 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
and woodstoves Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON T ISES
Certificate of Occupancy
Building Inspector