31D-142 BANK (15) Z
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICaATION FOR PERMIT TO ALTER Repair
Garage
1. Location S —T (?)c'-4 1 �t Lot No.
2. Owner's name S r r n Fie-W Z�},►T� �r �� dress 14 -.S r 4 YV)c',t Y `�1 3
3. Builder's name M�`n'r` vu"�1 �^ N',9— � Address 14,Z I 1 CNACe-e k 1 �
Mass.Construction Supervisor's License No. ®��r FS 3 Expiration Date 4 I 1 fn 2 Crb
4. AdditionA c-
.cel
5. Alteration R +r'7y (
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 YY--e t:.�rl est. r^
13. Siding house
14. Estimated cost- 6(c LTU-0 ,(Ju
J
The undersigned certifies that the above statements are true to the best of his, her
k dge and belief.
,cM-
� L..) „ ignnaiure ojresponsible app,icant
Remarks
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DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVTT
with a principal place
_of business/residence at-.
14-Z }� c-�►1Cy�l� S� jrlfl ��L� Mtn. 234-
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.
Cc r,- I n z n!S gra n Ce /C S A W C L_ 13 D L19 i sit 191
(Insurance Co.mpany) (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 Compauy/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date)
(Name of Contractor) (liuurance Company/Policy Number) (Expiration Date)
(attach additioml shod ifneoc=uy to include information pertaining to all co f,n n)
( ) 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 aw=dw whilo homeowners who ernploy pc son:to do m i•,tca= c�comuvction or rcpaic work on z dwrlliag of
not tnoco than throe twits is which the boax�oevna resides oc on the grounds appurtenant the rto arc not generally oot:sidurd to be
cmptoyaa under tbo wockcts eomp—thea Act(GLI 52,ss 1(5)),application by a homeowner for a Gccnx oc permd may evid—the
legal etahsa of en employee under the Wodcoet C.ompemation Aei
I undastaad that a copy of this sratcmcast may be forwarded to tho Dcpartr c of Iodaui d Aeddenb Office of Imurwoo for the
coverage vcnficadou and that failure to acatre covcmgv unckc section 25A of MOL 152 can Iced to tbrt imposition of---'pcaaltica
consisting of a-fine bf up to S1,500.00 andloc impmossmcsst of tip to one year and civil penatries is the form of a Stop Work order and a
firm of 5100,00 a day against me
�h
S, day of I)P-Le w l�pvt99-7 FCC&PUtM=W u,o coly
Permit Number
Map# I of#
Signature of LiPcrnnit#,c,-_
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_y
IF YES,describe size,type and location:
11 . ALL INFORMATION MUST BE COMPLEI*ED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
NThis colnam to be filled in
by the Building D�pnrtment
lRequired l
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
&paced parking;
# pf 'Parking spaces
# rof Loading Docks
Fill:
(volume -& location)
13 . Certification: I hereby certify that the information ontained herein
G is true and accurate to the best of my edge.
DATE: I Z- , G! APPLI CANT's SIGNATURE cM
NOTE: Issuance of a zoning permit does not: relieve an appliomnt's burden to oomply with ali
zoning requirements and obtain all required permits from the Board of Health. Conservtntion
Commission. Department of Public Works and other applicable permit granting authoritios.
FILE #
9 i99
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: Md-y-Y`1-5
Address: Ai� ��`�Cr t�–S�' � '� Telephone:
2. Owner of Property:'SP1117
Address: 1f 0 (n- 1n 5-0S'14. fV-\ ''N Telephone:
3. Status of Applicant: Owner �1 Contract Purchaser Lessee
Other(explain):
4. Job Location: 17 5c11Y1 Cj , vvv—�1'lc,r��c>� y� c�
Parcel Id: Zoning Map# Parcel#_ q District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property C5-q�1
6. Description of Proposed 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/Variance/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)
FILE # .�1 i, � ��
l
9 99 f,
APPLICANT/CONTACT PERSON: e &, ,�!
".I-ADDRESS/PHONE: '
PROPERTY LOCATION:
MAP 31D PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERNIIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZQNTNC� FORM VULET) OUT
Fee PAid
Fee PAid
Type of Constniction-
Zzn- '
Rprnndelin2 Interior
Build n2 Plan-, Tnrinded-
0,yner/Orrn pant Statement nr���
Lam'
THE kOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
p 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
I/
Variance Required under: § w/ZONING BOARD OF APPEALS
Received &Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut fr ater Availability Sewer Availability
ell Water Potability-Bd Health
Permit from Conserva"tr onfmissi n
y 9
Signature of Building Inspector Da
NOTE:Issuanoa of a zoning permit does not relieve an appltoant's burden to oompty with all
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commisslon, Department of Public), Works and other applioable permit granting authorttles.
City of Northampton REQUIRED INSPECTIONS
! M 1. Footings and Walls
BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
Office of the Building Inspector
No.
Zoning Form No. 963086 Date 12/10/97 Fee $264.00Check#
Page, 31D parcel 142 ,Zone CB Section 127 ❑ Yes No
Bul- ]LDINGPERmir
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Morris Roofing & Sheet Metal before Building Inspections
install carlisle mechanically fastened 45 ml EPDM
has permission to roof Inspection on Site—Foundations
situated on 175 Main st - siS 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(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON MI ES
Certificate of Occupancy
Building Inspector