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23D-013 .+ ,0 City of Northampton REQUIRED INSPECTIONS A ��`' �' 1. Footings and Walls a Wit, ..t. •�.;, , BUILDING DEPARTMENT 2. Structural Components in Place ' �' 3. Complete Building* No. 835 Office of the Building Inspector Zoning Form No. 962732 Date 9/8/97 Fee$40.00 Check# 1347 Page, 23D Parcel 13 ,Zone CB Section 127 ❑ Yes El No BUILDING PERMIT * Plumbing and Electrical Inspections required THIS CERTIFIES THAT Jeff Haskell before Building Inspections has permission to install new ply & shingles Inspection on Site—Foundations situated on 4 Nonotuck St - Janet Spongberg 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 ,/. MISES Certificate of Occupancy fi /roe-' Riuildinm Inspector FILE I 96 'w3r1 g35" APPLICANT/CONTACT PERSON: � ' , �fZ / ADDRESS/PHONE: o �'i i lk {l Q_ - / j 8I e Pt* PROPERTY LOCATION: MAP 3 0 PARCEL: l.3 ZONE (° [HIS SECTION FOR-0141CIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FTT,T.FT) OUT e' Fee Paid Building Permit Filled nut 62 `� - Fee Paid /3Y7 d 4 Type of Constnietion• New Construction Remodeling Interior L[K/ � Addition to Existing V Arrecsnry Structure Building Plane Tnrllided• Owner/Occupant Statement nr ,1CPncP .er 0 . G // 3 Sets of Plane /Pint Plan THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: 4' //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 Conservat' Co• n Y . Signature of Building b ctor Date NOTE:Issuanoe of a zoning permit does not relieve en 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 euthoritles. File No. ZONING PERMIT APPLICATION (S10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: e, Address: 6� l k 0 Telephone: 374 r cj 71 1 2. Owner of Property: I'1�rt. '}� r.� r �t�� r Address: Cl /1)0A)0) 0 C k S j Telephone: 5-76 — .S 3. Status of Applicant: Owner >s Contract Purchaser Lessee Other(explain): 4. Job Location: [;) a 0=A) 'u c S t t?►' .i•t/01 Parcel Id: Zoning Map# 1) Parcel# I District(s): C (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property Re„S 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): • — Roo e l =L►a—U L /U1 Ct) )1./ k rt)C i 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 PermitNariance/Finding ever been issued for/on the site? NO DON'T KNOW X YES IF YES,date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW X YES IF YES: enter Book _ Page and/or Document# 9. Does the site contain a brook, body of water or wetlands? NO X 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) 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 column 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) # of -Parking Spaces tfof Loading Docks Fill: volume -& location) 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowled e. ,I `�' DATE: ✓ ^ �� j / APPLICANT s SIGNATURE NOTE: Issuanoe of a zoning permit does not relieve an apf»I nrs bu- en comply with-all zoning requirements and obtain all required permits from t Board of Hea h, Conservation Commission, Department of Publio Works and other applioable permit granting authorities. FILE if z--tttAl-f pi a ,"re _e (rx Jai Narfl ampfnll 1 ,,,i, •"vUVfil ��6 ..asasrhnstlla ,..4.,...t., . -m- DEPARTMENT OF BUILDDIG INSPECTIONS t 212 Main Street • Municipal Building Northampton, Mass. 01060 `'��. WORKER'S COMPENSATION INSURANCE, AFFIDAVIT I, 3 L H ass licensec/permitte)(P l-1 s►�t..l L ( with a principal place of business/residence at: C� /I �� L..rKt _t Vi • (phone#),S—E "b©7F (str lIcity/stale/ap) 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: (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/Polic-y Number) (Expiration Date) (Nime of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Dale) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional thee ifneri-s<ary to include inform-anon pertaining to all contractors) it 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 persona to do trainf.-oan,r construction or repair work on a dwelling of not more than throe traits in which the homeowner resides or on the grounds appurtenant thereto arc not generally 000sidcrcd to be employers under the worker's compensation Ad(GL152,rs 1(5)),application by a homeowner for a license or permit may evidence the legal stama of an employer under too Woricot'a Compooeiiion Act I understand that a.copy of this r t.e.•,,,r.,t may bo forwarded to tfre Departmcrt of Industrial Aceideate 0Mo°of Iasuranoo for the coverage verification and that failure to secure coverage under section 25A of MOL 152 can lad to the imposition of criminal pcnaltics c omisiing of a fine of up to S 1,500.00 and/or imprisonment of up to one yca and civil penalties in the form of a Stop Work Order and a fine of S 100.00 a day against me. Si:Am ed this 9 y of Ilv us i , 199 7 For deosanneceal uae only kv Permit Number ►�/ Mapl{ Lot# Si: • • A of Licensee/Pe 'tics ,a cc, ' ea sio v -o .. X) M m o zm c: o R f S z m B y LA O Z —1 . v a M 1 Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. SY( • X 6 7 is *y Alterations iiikr%� NORTHAMPTON, MASS. k '..k.: '' 3 19 �� ! Additions }= A' APPLICATION FOR PERMIT TO ALTER Repair Garage • 1. Location L' M p ►uc K S 1 Lot No. 2. Owner's name JAru{,�i I Srr��efl,Jr�!ar cj Address 11 e'�'n N1 I��C'1�, S 1 3. Builder's name �jt_QC J4 S'Kr,l Address 6 I I A, ,A. r S Ic.ft Of Mass.Construction Supervisor's License No. 6 t' t3 I ( Expiration Date I rl. 1:i I / `'/ ,7 4. Addition 5. Alteration a t` - ( eO(? i,_: .Z 1«.1t_ vi',t,,i p2; (.ti0 4 (`t (/ 1 t % 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 13. Siding house 14. Estimated cost:- c(^, The undersigned certifies that the above s tcmcnts are true to the best of his, her knowledge and belief. AI- azure of respon ble appicanz Remarks