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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location /..Z3 ,114 e$1�4 sj Lot No.
2. Owner's name '��'� !/--; L Address
3. Builder's name /&,yr 6k,2 -5j Address ✓ �
Mass.Construction Supervisor's License No. 5�V 37J Expiration Date_ ` / ", �- -,
4. Addition
5. Alteration /r v- ✓r r lu C t f/I.r /lfrl
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-/�
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
Signature of responsible appicant
Remarks
O�(1tAMP�O
9 B Ala 3%Rchnsctta
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COT'dTENSA ION INSURANCE A i '' AV T
I,•
(li�nsee/permi ttee)
wit l a principal place of business/residence at:
(phooeif)
(str�t/ci ty/statrla p)
do hereby certify, under the pains and penalties of pegury, that:
( ) I am an employer providing the follotivi.ng worker's compensation coverage for my
employees wor—ng on this job: ,
Gasu=ce Company) (Policy Number) (Expiration Date)
( ) I am a ole propriet , general contractor or homeowner (circle one) and have hired
the contractors sted below who have the following worker's compensation policies:
(1,13me of Contractor) C011102ayiPotic-;NumCCr) (-Expiration Date)
Game of Contractor) (Exaimiion Date)
(Name of Contractor) (Lasuraace CompauyiPoLcy Number) (Expiration Date)
(Name of Contractor) (Inszlmc-- Comoamy/Policy Numb--r) (Expiration Date)
(attach amitic"sl cQ if nccusiry to toelude cfoe mi:icn pertaining wall oDat cto.�)
I am a sole proprietor and have no one wor4dna for me.
( ) I am a home owner perfornurlg all the work myself.
NOTE:please be awazc that v ailc homcoADm H,)o a=ptoy pernom to do tn,' rxxixruaioa'ar repair work oo i d«ctling of
not morn than tbroo unit:in wvtich the bomooumcr rczidct oc oa the grounds zpp.,nr,•,x tbcdo ut not Gcocmdy oomidcrcd to be
cmploym under tha veockcr`s a;mpeuatien Act(GL 152--s t(5)),appli=.6on by a homcow wr for a Hecate er permit may ev:deoee the
legal rtaht=of an omployoe under tho Woricoes Compomxtioa Act
I understand clot a copy of this mtcmmt may bo fora-ru to the Dc�of J.&,,t i nl Aead--&Of —of In—for th.
coverage wrificatioa and that failure to secure co,c-T b under scctioa 13A of MOL 152 can I'd to tbd imposition of Criminal pcatltics ;
ooaust mg of a-f nc-of up to S 1,500.00:ndlot imprisomxat o£tip to one year and cjA pcnalti a is the form of a Stop Work Ordcr and a
fine of S 100.00 a day against tn_
For&P,ata-C"l ttao only
Permit Number
i
_. Sign.-ttuzir o£LiccnscdPermitiec grR y .
r. - ;�.t�.�'v�ai`,�" 4., yW..: ., _ _ „..tW ...rPy6aN✓tN.R[:fJ.:A. ' !
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 is
by the Building 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
f of Loading Docks
Fill:
4vo1-ume--& 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: lssunnoe of a zoning permit does not relieve an appiioant's burden to oom wit ~
zoning requirements and obtain all required PrY Ip .ill
q permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applionbla permit granting authorities.
FILE #
L.rG T r 3 - File e No.& ; l&/
ZONING PERMIT APPLICATION (§I0 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: '—/2111 1 _t
Address: .2z,7 7 / /f 12 Telephone:
2. Owner of Property:
Address: /-2.3 �.�f I'/ Telephone:
3. Status of Applicant: Owner _Contract Purchaser Lessee
Other(explain): J
4. Job Location:
Parcel Id: Zoning Map# � Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed UseAlVork/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 PermitAlariance/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#BP-1999-0430
APPLICANT/CONTACT PERSON Thomas Gross
ADDRESS/PHONE 237 Plumtree Rd(413)665-8235
PROPERTY LOCATION 123 HAWLEY ST
MAP 32C PARCEL 219 ZONE SI
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out �--�
Fee Paid 6,�
Type of Construction:
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Occupant Statement or License# '
3 sets of Plans/Plot Plan
THE�FOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
d 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
if; }4araFHealth' Well Water Potability Board of Health
Permit from Conservation Co ission
--� ' --le
L
Signature of Building Of cial Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
Department: Reference No: BP-1999-0430
........................•.•........
Building, Electrical & Mechanical Permits
Fee Type: Receipt No:
Non structural interior renovations RE;C-1999-001142
.........................................................................................
...... ...............................
Paid By: Paid in Full On:
Thomas Gross Fri Oct 23,1998
.........................................................................................
.. . ...... ......
Received By: .Check.No:...................Linda Lapointe 2678
.........................................................................................
.................•.....•..............
DEPARTMENT'S COPY Amount: $40.00
...........................
[WPARTMEINTFILE COPY 123 HAWLEY ST
CITY OF NORTHAMPTON
BUILDING PERMIT
Owner's pulling their own permits or dealing with unregistered contractors for applicable work do
not have access to Guaranty Fund(MGL 142A)
Issued: Permit No: Inspector: Tracking No.: Fee:
BP-1999-0430 $40.00
GIS Map Block: Lot: Address: Zonin2: Use Group: Lot Size:
10240 32C 219 001 123 HAWLEY ST Sl 14766.84
Contractor: License Type: Insurance:
Thomas Gross CSL
Address: License No.: Insurance No.:
237 Plumtree Rd 059093
Li!E State: Zip Code: Phone:
SUNDERLAND MA 01375 (413) 665-8235
Project No: Catetiory of Work: Const. Class: Cost Estimate:
JS-1999-0838 Non structural interior renovati $800.00
Description of Work:
INSTALL FIRE RATED ACOUSTICAL CEILING
GeoTIVIS@ 1997 Des Lauriers&Associates,Inc. Signature: