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38-048 (5) ,. �,I i �� i III --1 a .v O > N Zm - -s Z cn-- o �I Z x m Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MASS. ��y �� —19 "7 7 Additions = Repair ' APPLICATION FOR PERMIT TO ALTER 7- �,/, Garage 1. Location S I XC.Y'tt-ry , I> Lot No. 2. Owner's name /�c i /U�f61'�h /-�_ _- Address 3. Builder's name(�/�� /�f.�QM OL-r'� p\,c-L) Address Mass.Construction Supervisor's License No. fT -16k �j > Expiration Date 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 _ T 12. Type of roof �P��^6)J%A, 1e /JA 13. Siding house y�L'PS 14. Estimated cost- 7'� d The undersigned certifies that the above statements are true to the best of his. her knowledge and belief. e!��4 LSignature of responsible appicant Remarks ✓1 UU - rc, `y.0 L c S5 T II • o�Tt1A1NP�0 s� MAI 2 21997 Gl it r of ��#I�ttnt�#nrt z k $ 6 c:� �lassRCllnsctta `,D&FARTMENT OF BumDrNG INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT I, �evl n e U 1I 1e (Iicensee/pennittee) with a principal place of business/residence at: yt� (Z 'rl y�fii� V ( klA. , ovt) (phone#) (strret/city/sta& '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: (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) (Insurance Company/Policy Numbcr) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Date) (Name f Contractor) (Insurance Company/Policy Number) (Expiration Date) (attadt ' oml ifnoc", Iy to include udotmaaon pertaining to an oca ractors) (/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 employ pc==to do maimcnanc,construction or repair work as a dwelliag of not Moto than three units in which the homeowner resides or on the grounds appurtenant therdo are not generally oomidered to be employers under the vmrk es.00mpensation Act(GL 1 52,ss 1(5)),application by a homeowner for a license cc permit may evidence tho legal statue of an employer under the Worker's Compensation Act I understand that a oopy of this statement may be forwarded to the Department of ln, t al A=dca&offioe of Instunnce for the coverage verification and that failure to secure coverage under section 25A of MOIL 152 can lead to the imposition of criminal penalties of a fine of up to$1,500.00 and/or imprisomnent of up to one year and civil penalties is the form of a Stop Work Order and a fine of 5100.00 a day against me. Signed this v� 3 day of t 199 7 For departrocctal—may Wy Permit Number V Map# Lot# Si LicroseelPetmittee 10. Do any signs exist on the property? YES_ NO IF YES,describe size,type and location:_ i I 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 corm to be filled in by the Building Department Required Existing Proposed By Zoning Lot size Frontage Setbacks - frnnt - side L: R: L: R: - rear Building height Bldg Square footage %Open Space: (Lot area minus bldg ' &paved parking) # Pf -Parking spaces of Loading Docks Fill: '_(vol me--& location) 13 . Certification: I hereby certify, that the information contained herein G, is true and accurate to the best of my knowledge. D21E: f ' E' �� APPLICANT's ,SIGNATURE A- 4 ?" NOTE: luau 9fio4s of a zoning g permit does nod relieve an appli ant's burden to comply witfl,,aU- zoning requirements and obtain all require4l permits from the Board of Health. Conservation Commission. Department of Publio Works and other applioabla permit granting authorities. FILE # I} MAY 2 2 087 File No. ZONING PERMIT APPLICATION (§I0 . 2) PLEASE TYPE OR PRINT AL,� INFORMATION ( � 1. Name of Applicant: ��/�'1 1 I / I� Address: 7c) (�Qsef�/J"�f�v✓ 12) , Telephone:_ K13 5�-7 V -25 2. Owner of Property: (-4L/ /�/v✓. Address: J j Telephone: 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): 4. Job Location: �l Lj ^c�✓ Parcel Id: Zoning Map# 7� Parcel# District(s):p`a � (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property _ y U M e Les 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): p 61 fyv =S h ,5+/z, L L 4CCe7sd /I e S 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 bee 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 c/� 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) i FILE # a7 E j 9 MAY 2 2 M7 75'APPLICANT/CONTACT PERS N: ADDRESS/ NE: PROPERTY LOCATION: 9z hieve- -1 L4�1� MAP � _ PARCEL: ZONE,l/f THIS SECTION FOR-OFFICIAL USE ONLY: PERNUT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM EH.I.FD OUT Fee PAid 'Riii fjin2 Permit Filled nut F J T EE 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/ZON NG 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 —PerruiUxom Conservation mission Signature of Building hislOor Date 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 Publio Works and other applioabla permit granting authoritles. g2��s "• City of Northampton "" REQUED INSPECTIONS REQUIRED BUILDING DEPARTMENT 2. Footings and Walls * � Structural Components to Place 3. Complete Building* No, 455 Office of the Building Inspector Zoning Form No. _ 962291 Date 6/2/97 Fee $-0— Check 4P000000000 Page, 38 Parcel 48 Zone UR.B Section 127 ❑ Yes © No DUH_.,D1NGPERM1 * Plumbing and Electrical Inspections required THIS CERTIFIES THAT Adam Quenneville before Building Inspections has permission to _strip & reshingle roof Inspection on Site—Foundations situated on 91 Grove street 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 ternis 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 P C OIT� �}r[/1��/1(ISES Certificate of Occupancy Building Inspector