17C-314 T A
._... � it � � _• Z'1
ILO 3 C O ,✓D,
�p -7 ZZ�J
i Z
Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location .y 3 -AIQ 3— `44K F.r-7 c f Lot No.
2. Owner's name A^/i)✓LV 5 Address f
3. Builder's name �,�✓LcJ�_ rr/Y✓�c7yl Address
Mass.Conswction Sup rvisor's License No. ��4 GQ 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 //
12. Type of roof SDha 1f/-- z - 04) f- VV d y li 12 It
13. Siding house
14. Estimated cost:- ad
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible app scant
Remarks
�1US 6 199(
(-Ei i of Wart4amptan
9 �` �ixaaxcyuactb
DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
/l WORHER'S COMPENSATION INSURANCE AFFIDAVIT
(liven-Wiperulittee)
with a principal place of business/residence at;
r � f�� i(Ar-19 L,3, (phone#) 5R[o - (Q0J•7
(strtet/city/state2ip)
do hereby certify, under the pains and penalties of pedtuy, that:
Qq I am an employer providing the following worker's compensation coverage for my
employees working on this job.
(InstuanceCo airy) — (Policy Number) (ExpuationDate)
( ) I am a sale 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) (Expimdon Date)
(Name of Contractor) (Insurance Company/Pobcy Number) (Expiration late)
(Name of Contractor) (Insurance Company/Paky Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/PoUcy Number) (E)piration Date)
(quart additioual area ifneoenary to c,c)ide information pcctzia=g to all 000tradors)
( ) I am a sole proprietor and have no one worsting for me.
( ) I am a home owner performing all the work myself.
NOTE:pltxse be awaro that while hoaeowaen who employ persons to do mauatwance,wowuctioa or repair work on a dvmU!ag of
not mace than thtna traits is which the haatoowaer reaidrs or on the groands tgp ttenjm thacw ate pot Vaowdty consWemd to be
estiployets utsdet the vsm*xs's co=peasation Act(GL15Z=1(5)),application by a homeowner for a 6c am a peatttd may evide n-the
legal status of as employer under the Wockee,Compamation Ant.
I understand that a oopy of this statewm a may be forwej%W to the Departmart of 1t1& sI Aaddaa&OBoe of]mussnos for the
covmge vaificW00 and that Wwt:to secure covaragn uodar section 25A of MOL 152 can lad to the impo 3ioa of aimbW peu!403
oomistiag of a fine of up to$1.300-00 and/or irvrctoamcm of up to one yt w aid civil pt axWes in the form of a Stop W otir.order and a
fine of S100.00 a day against toe.
Signed this Tzday of 1997 For&p==m l—only
Permit Number
Map# Lot#
Signa7 iccnseelPemxitton
10. Do any signs exist on the property? YES NO X
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 column to be filled in
by the Banding 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
Vfof Loading Docks
Fill:
'4 vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
_1
DBE: APPLICANT's SIGNATURE
NOTE: luouanoe of a zoning
g permit does not relieve an applicant's burden to comply wit4,,all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
-
FILE #
AUG 61991
Fi l e No. L �3 1
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1
1. Name of Applicant: ,��uJ S I�Jc 4 d>'J
Address: r Telephone: -5:fh—/a9 3
2. Owner of Property:_j v A&t2-0 S
Address: '6CL cam. Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): /
4. Job Location: z2,3 4,*, L �� �/U✓L�yIG�
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)-
5. Existing Use of Structure/Property ,' As? h
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
nl ni G
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 PermitNadance/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)
y 96 '633
r
FILE #
AUG 6 199(
` APPLICANT/CONTACT PERSON: �X
ADDRESS/PHONE:
PROPERTY LOCATION: Idt � 4 -1.,9
MAP ,7(? PARCEL: ZONE
THIS SECTION FOR.OFFICIAL USE ONLY:
PERMH APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM VEILED OITT
Fee Pnid
Iliiilding Permit Filled nilt
Fee PAid
New Cnnstrjirtinn
o�
THE LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: <
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 ommissio
e5/,;�
Signature of Building h1wMr bate
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 authorities.
City of Northampton REQURED INSPECTONS
BUILDING DEPARTMENT 2. orngs and Walls
Structural Components in Place
3. Complete Building*
No. 743 Office of the Building Inspector
Zoning Form No. 962633 Date 8/7/97 Fee $20.00 Check# 938
Page, 17C Parcel 314 ,Zone URB Section 127 ❑ Yes ® No
BUI]LDINGPERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Newman's Construction before Building Inspections
has permission to shingle over existing 1 layer Inspection on Site—Foundations
situated on 23 Lake St - Floyd Andrus 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 P CE ON T P ISES
. Certificate of Occupancy
Building Inspector