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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. 01 Tel.No. 7 21 y I Alterations
NORTHAMPTON, MASS. 19�� Additions
APPLIC N FO PERMI TO ALT Repair
Garage
1. Location -e Lot No.
2. Owner's name Address i �1
3. Builder's name 4a Address
Mass.Construction Supervisor's License No. 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 o
13. Siding house "
14. Estimated cost:- ✓ '
The undersigned cenifie that the above s tcments are true to the best of his, her
knowledge ie �
Signature of r sponsible appicant
Remarks
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b 1997 rx of 'Wart4aillvton
a �asaachnartla
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DEFT Of Pry 'N' t
�iP*TMENT OF BUILDING INSPECTIONS ~
212 Main Street ' Municipal Building 'o
Northampton, Mass. 01060
wo R'S CO EN TION INSURANCE AFFIDAvrr
L
(iicensee/permittee)
with a principal place of business/resi ence at: (1 � 2 e_1 z
(stet et/crty/statehip)
do hereby certify, under the pals/and penalties of penury, 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)
`-4.La_m 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 additional shed ifnecentry to include irdbnnation pertaining to all 000tractors)
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 consmx tion or repair work on a dwelling of
not more than throe units is which the homeowner resides or an the grounds appurtenant thereto are not generally considered to be
employers under the workers compensation Act(GL152,ss 1(5))�,application by a homeowner for a license or permit may evidence the
legal status of an employe under the Wodceea Compamation Act_
I undexataad that a copy of this statement may be forwarded to the Depumaead of Industrial Aoddoo&office of hhauraaoe for the
oovaage verification and that failure to secure coverage section 25A of MGL 152 can lead to the inVosition of criminal penalties
consisting of a fine of up to$1,500.00 andfor' of up to one year and civil penzl is in the fotm of a Stop Worst Order and a
fine of 3100.00 a day agaiast the
Signed da -of
For deputweaw use only
Permit Number
7 Map# Lot#
Stgnakire of Li ermittee
10. Do any signs exist on the property? YES NO JUL
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 aoluam 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
f of Loading Docks
Fill:
Avol-ume--& location)
13 . Certification: I hereby certify that the informpat a�n conta '�d herein
is t e d accurate to the best of my kno edge. `
DATE: 4J ; '" APPLICANT'S SIGNATURE
Ii'; NOTE: 1 of ion `
g permit does not relieve an a ioant's b en to oomp"ly awttt� .ill
zonin req i ments and obtain all required permits i m the Board of Health. Conservtation
Com 100140 Department of Publio Works and other applioabla permit granting authorities.
FILE #
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b 1991 ';
1
LI)EK�OF-131J:O
File No.- _��1"�
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE E OR ALL INFO TION
1. Name of Applicant:
Address:
2. Owner of Property: p
Address:
3. Status of Applicant: Owner ;;�Contract Purchaser Lessee
Other(explain):
4. Job Location: 4L '�. Z� z Z:za -
Parcel ld: Zoning Map# 1-7—PI Parcel# _Z_' District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property 'Z-t °L---C—c
6. Description of Proposed Use/Work/Project/Occupabon: (Use additional sheets if necessary):
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7. Attached Pla s: 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 Perm it/Va dance/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)
$ D• � �� � FILE # 2 j� , V
At 111
�PL7'C� ONTAC ERSON: 7 7
DEPt of�� ESWH�I NE:
PROPERTY LLOCATION: _
MAP PARCEL: ZONE"",
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THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FRIED OUT
Fee pnid
Rnilding Permit Filled mit
7� � .
THE 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/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 Healt Well Water Potability-Bd Health
_ it fr co 'on Sion
Signature of Building 4zpector Date
NOTE:issuanoa of a zoning permit does not relieve an applloant'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 applioabie permit granting authorities.
City of Northampton REQUIRED INSPECTIONS
a
1. and Walls
BUILDING DEPARTMENT 2. Strucntural Components in Place*
3. Complete Building*
No. 670 Office of the Building Inspector
Zoning Form No. 962542 Date 7/21/97 Fee$20.00 Check# 5838
Page, 17D parcel 45 ,Zone uRB Section 127 ❑ Yes ® No
BUI]LDINGPERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Robert Thibodo before Building Inspections
has permission to strip & reshingle roof Inspection on Site—Foundations
situated on 66 Straw Ave - Florence - Amy Hague 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 PLACE ON T ISES
Certificate of Occupancy
Building Inspector
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