32C-219 (47) a
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Zoning
Miscellaneous Additions, Repairs,Alterations,etc. Tel.No. Alterations
a NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location J Lot No.
2. Owner's name fsG r Address
3. Builder's name �r 1�° / i/* �E Address . 0 O�d�c���'/71� �4ar.��
Mass.Construction Supervisor's License No. G-TO 2&7: Expiration Dates 3
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
13. Siding house
14. Estimated cost-
The undersigned certifies that the above statcments are true to the best of his
knowledge and belief
Signature of responsib t app icant
Remarks
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JUN 1 6 19 9 Gitt of Wart4amptan
iSf RtanTf 114
DEPARTMENT OF BUILDING INSPECTIONS
212"Main Street ' Municipal Building
Northampton, Mass. 01060
WOR=R'S COMPENSATION INSURANCE AFFIDAVIT
(li
with a principal place of business/re-i ence at:
(phone#) Vi>
(strc-/city/star zip)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the foilollving Worker's compensation coverage for my
employees working on this job:
(I.nsu=ce Cgrnpacry)
(Policy Number) (Expiration Date)
( ) I am a sote propri etor, general contractor or homeowner (circle oae) and have hired
ic contractors listed below who 'Have,to fo1loVqi21g worker's compensation policies:
Ac,�J5 10z
(Name of Contractor) (—_ Commuy/policy Nullbcr) LraKoa Date)
(Name of Contractor) NuL-nbe-i (Expiration Date)
(Name of Contractor) � (��rancr ComE ,Policy Numb, ) (Ex-pimdon Dale)
(flame of Contractor) (Ins nc- CoIIIp olicy Nur,lts) (Expiration Date)
(a213G31 i•lOQ3.t z�1CCt l.�Dtr'-C11'}'to^.?C�li�c 1S1f9CIIliL1 CQ�'.7h:II1RD�LL1 a�ccdyd9ri�
l I m-n a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE_pl==at be aw;xm thzt wtmo 6cmcowDcr3 wbo crrploy paeans to&m•;•.: coc=vcUoc or rcpair work ca i dsvctling of
not mocv than Ihrco train is which 0-_bo=.50N cr midi a m tbo Voumd_i appurtcnact tbCdv arc not gm.-Ally oc,r_ crrd to be
cmployas under tba worka s. skim Act r-r Last=by a homcowmcr fer a lice=of permit=Y cvidcnoe the
legal rtatua of an amployer unda-the Worked[C,onapomaiioa Act
I ccadcrstnad thss x coYY of thu ctsScmcnt may bo forwarded to rho I?cpertmcat of Industrial Att�dmis•O1Soe of Imcu+me for the
coverage vrrificstioa mid tbat failure to aoatre cov=V under socuoa 25A ofMOL 152 can lead to the imposition of criminal pcaaltics i
000sistiag of rt fine of up to S 1.500.00 tmd/or imprisoemrs of tip to oae year Lod civil pcznitirs is the form of a Stop W orlc Ordrs aid a
faro of Stoo.00 s day ag=hast ma:
9 For dgatmmtat uw oaly
Permit Ntunber
Lot�
t _—
Sre of Li crmitc o
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 e------
IF YES,describe size,type and location:
11 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
Thin colIImn to be fi2led in
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 parkingi
# of `Parking Spaces
# rof Loading Docks
Fill:
-(volume -& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: G APPLICANT's SIGNATURE
NOTE: Is a e f a zoning permit does not relieve a plicant's burden to oo ply with""%jl
zoning requirements and obtain all required perms rom the Board of Health Conservation
Commission. Department of Publio Works and other applicable permit gr authori t s.
FILE ,
L1--1 10111,0.191
/file ls '
°t bC� File
'Z ' PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: A-/13O)c Telephone:
2. Owner of Property:
Address: ZZ3 ® C' Telephone:
3. Status of Applicant: Owner z_--contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
i
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
J r
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.
S. Has a Special Permi dance/Finding ever been issued for/on the site?
NO /DO 'T KN0Al YES IF YES,date issued:
IF YES: Was the p corded 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-1999-1106
APPLICANT/CONTACT PERSON James Marley
ADDRESS/PHONE P O Box 168 (413)253-2798
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 ,jor,
Typeof Construction: CONSTRUCT TEMPORARY HANDICAP RAMP
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 030787
3 sets of Plans/Plot Plan
q THE LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
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 Board of Health Well Water Potability Board of Health
Permit from Conservation Commis
� 9
Signature of wilding Official 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.
123 HAWLEY ST BP-1999-1106
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C-219 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:alteration-addition BUILDING PERMIT
Permit# BP-1999-1106
Project# JS-1999-1836
Est.Cost:$1500.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: James Marley 030787
Lot Size(sq.ft.): 14766.84 Owner: FOURNIER FRANK N III&
Zoning: SI Applicant: James Marley
AT. 123 HAWLEY ST
Applicant Address: Phone: Insurance:
P 0 Box 168 (413) 253-2798
BELCHERTOWN 01002 ISSUED ON.6118/1999 o:oo:oo
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT TEMPORARY HANDICAP RAMP
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Final: Final:
Rough Frame:
Gas Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
C=ertificate of Occupancy Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 6/18/1999 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo