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17D-048 (4) v D 00 M Z° m Z � O � Zoning Miscellaneous Additions,Repairs,Alterations,etc. C� Tel.No. Alterations 40 NORTHAMPTON, MASS. 19 Additions APPLICATION FOR PERMIT TO ALTER Repair }- J�n Garage 1. Location � -S r t'�1 �� Y-e ``� 4? Lot No. 2. Owner's name A- -rV c, a h .S'L�, Address 7 p s N 6w j¢-L e , f l Jr-eyc-C 3. Builder's name E-15, Lc Z,U i o ,0 .0 /k LOC Cc a f?V V/V(,ICddress Mass.Construction Supervisor's License No. 0c)2/7 F Expiration Date —1 4. Addition 5. Alteration ilv� tt ! Gri► c �V►+ -e Gr- (��e wy �t t' 1-c3e Etta 6.Leh 2 �� h S►�Jln't� 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- 3�0 b,ou The undersigned certifies that the above statements are we to the best of his, her knowledge and belief. Signature of responsible app icant Remarks 4�VLAMP 'moo - • • �liaDaCl�ttB[tta m DEPARTMENT OF BUILDMG INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION 77I��NSURANCE AFFIJ)AVTT &c el J, L0 C0 C,fi 116 4- L JGJCco (liomserJpermittee) with a principal place of business/residence at: O 1�c3�` f. ra tc / (phone#) J (� (strt Uci /stal Zip) do hereby certify, under the pains and penalties of pegwy, 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 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 additioaal sled if noocnary to incitrde informaIIoa pertaining to an ooatrt d rs) l 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 homeowncra who employ persons to do maintcaance,c=tmctiou or repair work on a dwelling of not more than three units is v�cfi the honwwncr resides or on the grounds appurt=wA thereto are not gcaenily oonsidcred to be employers undocr the avarice's oompcnssdion Act(GL152,ss 1(5)�amlicatian try a homeowner for a license or pcmd may evidence the legal stsdus of an employer under the Worker's Compemation Act. I understand that a copy of thin siatca cal may be forwarded to the Depw tx s of Industrial Acrid en&Offioc of k%Amoce for the coverage verification and that fallu m to beatro oov=v under sectioa 25 A of MGL 152 can lead to the imposition of criminsl Pena - oonsi-6ng of a fine of up to S1,S00.00 and/or imp of up to one year and civil penalties in the form of a Stop Work Order and a fine of s 100.00 a day against me. Signed this _day of — 199 E41 m�l �y Number �Z,r Lot# Si Of Li 10. Do any signs ebst 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 —1— to be filled in by the Bni.lding ZWpartment 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) # pf Parking spaces #1 fof Loading Docks Fill: Avoi-time--& location) 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. DATE: APPLICANT's SIGNATURE NOTE: los anoe of a zoning permit does not relieve an a ant's burden to oom P Ply,wittx_$II zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Department of Publio Works and other applionble permit granting authorities. FILE # SFP 8199 File No. 1�74& 1 ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: T, GoCOcU 12ZIi z'ae�ccq Address:SCE V C'T&Ilw Telephone:,SF/f`— ©�'T F 2. Owner of Property: tv1(f �10„ r %a vt 't"v► Address:—'?,?' A-If'ei F( o dkC.(,. Telephone: ( � �0CID 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): 4. Job Location: Parcel Id: Zoning Map# /70 Parcel# `�_ District(s): (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property 6. Des nption of Proposed Use/W k/P gct/Occupati : (Use additional sheets f necessary)�er:c_ f e P c 114 ? �n C�c l" !o C� d �n -e�CN L- L) d r o C,) 4)0 t-'�S ly 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 Ll_� 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) FILE # 60 SEP 8 ?y APPLICANT/CONTACT PERSON: ADDRESS/PHONE: U s7-' PROPERTY LOCATION: 2Z _&2-da MAP /'j j) PARCEL: ZONE L'/L- THIS SECTION FOR�OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FULED MIT Fee Pnid jBiffldin2 Permit Filled nvit a O' 795 THE LLOWING 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 I/ 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 Conservation Co ission C° Signature of Bm din to Date NOTE: Issuanoe of as 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 applioable permit granting authorities. City of Northampton REQUIRED INSPECTIONS e I. Footings and Walls BUILDING DEPARTMENT 2. Structural Components in Place* 3. Complete Building* No. 857 Office of the Building Inspector Zoning Form No. 962760 Date 9/9/97 Fee $40.00 Check# 1369 Page, 17D Parcel 48 ,Zone URB Section 127 ❑ Yes 0 No BUI]LDINGPERMIT * Plumbing and Electrical Inspections required THIS CERTIFIES THAT E J Lococo before Building Inspections repair concrete block basement wall & relocate has permission to downspout pipes Inspection on Site—Foundations situated on 78 Straw Ave - Thelma Manson Inspection of Plumbing—Rough provided that the person accepting this pen-nit 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(Fire Department) Other THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS A-CE ON -PREMISES Certificate of Occupancy Building Inspector