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17C-282 (4) a ,_, L Z m C n � O � r v Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MASS. q Additions a APPLICATION FOR PERMIT TO ALTER Repair Garage 1. Location � '�^ _ S CJ/C6.? Lot No. 2. Owner's name- Address �� 3. Builder's nam j Address Mass.Construction Supervisor's License No.=!?Z 6:.� Expiration Date�S=�I � 4. Additi on 5. Alteration ' 6. New Porch 7. Is existing building to be demolished? 8. Repair after the fire�C� 9. Garage J(M No.of cars Size d 10. Method of heating 11. Distance to lot lines� � " 12. Type of roof C) 13. Siding house 6 14. Estimated cost-�-- ,�,D, L� The undersigned certifies that the above statements are true to the best of his, her knowled a and belie . Signature of responsible app lcant Remarks R . r2 MAY 51997 - Git� of Wort4anrpton • ♦ � N W , ,l DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 °'M 5�•` WO COMPENSATION INSURANCE AFFIDAVIT (licensee/permittee) with a principal place of b ss/residence at: / e (phone#) 3 'c � ( /stateJzip) 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 worldng on this job: (f n Ci (Insurance Company) (Policy Number) - (Expiration Date) ( ) I am a sole proprietor e�contract or hom eowner(circle one) and have hired the contractors listed below who have the following worker's compensation policies: (::D C3 G (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) Q (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) el� C3 (Name of Contractor) ([nsurance Company/Policy Number) (Expiration Date) d (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional sheet if necessary to include information pertaining to all ooaftctors) 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 persons to do maintenance,suction or repair work on a dwelling of not more than three units is which this ho neowner resides or on the grounds appurtenant thereto rue not gmeralty considered to be employers under the worker's oompemtatim Act(GLI52,ss 1(5)),application by a homeowner for a license or permit may evidenoe tho legal status of an employer under the Woske es Compamation Act. I understand that a copy of this statement maybe forwarded to the Deputwmt of T-&, ial A,00idaots•offioe of lasuronae for the coverage verification and that failure to secure coverage under section 25A of MGL 152 can lead to the imposition of criminal pemltiea oonsisting of a fine of up to SUOO.00 stWor of up to one year and civil penalties in the form of a S top Work Order and a fine of$100.00 a day against im sign this day of 1995 For aepatmeutsl sae only Permit Number Map# Lot# Signature of icenseelPermittee \ / See reverse side fnr ingtructinns 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 Banding Depart—nt Required Existing Proposed By Zoning Lot size Frontage `� r Setbacks - side L: _R: L: R: - rear Building height Bldg Square footage %Open Space: (Lot area minus bldg " &paved parking) V _pf `Parking spaces f fof Loading Docks Q Fill: vol-ume--& location) 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. _i 'f APPLICANT's SIGNATU NOTE: Issunnoe of a zoning permit does not relieve an applioanrs hurdan to oomply wide,Apll zoning requirements and obtain all required permits from the Boar4d of Health, Conservation Commission, Department of Publio Works and other applioabla permit granting authorities. FILE # f MAY 1 5 997 I� €DEPT OF BUii 'tG INSPECT ION S File No 9&d�7� 1 t r .; t �a�t C,�tl �, ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYP O PRINT ALL INFORMATION 1. Name pplica -- �ZD Address: Telephone:J b 'cam`©�T 7 2. Owner of Prope C, Address: Telephone: ..5:: "" j 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain)( ,��� A 'MJVZ— 4. Job Location: Parcel Id: Zoning Map# Parcel# District(s): �� (T6 9E FILLED IN BY THE BUILDING DEPARTMENT)` 5. Existing Use of Structure/Property 6. D c 'ption of posed 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 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) n, FILE # 962 ,15o 3 l L T/ TACT PERSON: � 01 D OF NORRTHAMPTGrPJ. 'A O1060 ` PROPERTY LOCATION: MAP .17e— PARCEL: ZONE '----- THIS SECTION FOR�OFFICIAL USE ONLY: PER UT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM OUT EPP Paid Type of Constniction- try TH�'FOLLOWING 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 m Conservation mi sio Signature of Building hispe2o Date NOTE:Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits from the Board of Healthy Conservation Commission. Department of Pubiio Works and other appiioable permit granting authoritles. Cit y Northampton TIof REQUIRED INSPECTIONS ! 1. Footings and Walls BUILDING DEPARTMENT 2. Structural Components in Place* 3. Complete Building* No. 403 Office of the Building Inspector Zoning Form No. 962250 Date 5/16/97 Fee$40.00 Check# 2076 Page, 17C Parcel 282 ,Zone URB Section 127 ❑ Yes 0 No BUI]LDINGPERMIT * Plumbing and Electrical Inspections required THIS CERTIFIES THAT Frank Denno before Building Inspections has permission to repair porch Inspection on Site—Foundations situated on 18 Lilly ly_St — Daniel 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 Smoke Detectors(Fine Department) Other THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS P CE ON P ISES Certificate of Occupancy Building Inspector s