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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. ` Tel.No. �� �r� �J Alterations
1 NORTHAMPTON, MASS. ` �r y 19-1 Additions
•'
• ' APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location ,��- Y�K /}�U f/ h�. h `v h , `/ Lot No.
2. Owner's name �5 l �� Ct- K C k 2 Address 15J- /X, 1,ye k�f
3. Builder's name Q Y)-e S U-t 0 Jj A i Address : J
Mass.Construction Supervisor's License No. ��� Expiration Date `/���!/ i�
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 statements are true to the best of his, her
knowle ge and belief.
1
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Signature of responsible appicanf
Remarks
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORZCER`S COMTENSATION INSURA-NCE A t , AVTT
ez-)jo l�S/
(li c°nsc^Jpermi ttcc)
with a principal place of business/resideoce at:
do hereby certify, under the pains and penalties of perjwy, ihai.
O I am an employer providing the following rror�ci's compensation cove age for rnY
employees wor-Liog 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) Qnairanc_- Company/Policy Number) (Expire6on Date)
(Name of contrzctor) (1»surancz- Compauyi?o!icy Number) (Expiraooa Date)
(Name of Conixaclor) (tnsuranc-_ Compaaay/Pobcy Numbu) (Expimboo Dale)
(Name of Contractor) (Iasu=C_- Comparry/Poky Number) (Expiration Data)
(e 11th zdditica l rlwd ifaooa=v T to iacli>dc infwm Eo(j pat.iaing to all eoa:, Co )
( 1 a sole proprietor and have no one worLq for me.
( ) I am a home owner performing all the work myself.
NOTE:plcax be Awarc thai winJo boa=vmcrz wbo cruploy persom to do m.immiocc ooastry ion-or rcpzir wont oa a dx ding of
not mocc th--n tlttuo Units is vAncft the bomoovv rmido ec oe the gvunds xpputteosut tbcr t e c oot Ccaamily 000sidcmd to be
cmplaym under d-%—kcr x riioa Aa(GL152,:1(5)1 a.pplintioo by a bomcow=far a Gecax cc perma may evidmec the
lcgi!rtaiva of an employx Uradee tho Wocicolc Campoosaiion Aoe.
I undcxtaad thai a Dopy of thu matrmmt may bo forwandsd to the Dopartmmt oflndzltrial Aocida&offs a cf Iraurzooa for the
oovrra ge vaifiestic a and lbnt failure to socurc cova%v u odcr sowoa 25A of MOL 152 can feed to tbo'imposition of cciminsl pcaaw-
ooasist wz of a one bf up to 51,500.00 salvor iurpraoam=d of up too=y=and civil pcaaJGa in the foem of a Stop Work Ordcr and a
fiw 0(:S 100.00 a dxy LpinA me.
Signed this C?\ �_day of ,J" 1997 For dew uao oaty
Malt Number
Lot#
Signature of Liocns=/Pcrmiti;cc
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 cc?== to be filled in
by the Banding 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
&paired parking)
# of Parking spaces
rof Loading Docks
Fill:
vol-time--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowle ge.
D7OE: ,�u 1 y��� � y `�� APPLICANT's SIGNATURE C c�
r" NOTE: Issuance of a zoning permit does not relieve an applioanta burden to oom wit
zonin requirements end obtain all required p� ail
g req q permits from the Board of Health. Conservation
Commission. Department of Publio Works and other applioabla permit granting authorities.
FILE #
JUL 2 41991
Fi 1 e No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:_j tl S l 3-D C" ee-)�0 S/f
Address: 'fir} ePT4j S?- C h Telephone: '7
2. Owner of Property: 4,-- 57e k c i k 2,
Address: c 57- Telephone: 5 5,�z
3. Status of Applicant: Owner �' Contract Purchaser Lessee
Other(explain): /
4. Job Location: -5 S/ IYc°✓//i ter_ Ai /✓/�'%�
Parcel Id: Zoning Map#_yam Parcel#_c _ District(s):-k{.
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property f�Y
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)
A F D 2�i Q/�
41997 0 -9
2 FILE # �
r.
APPLICANT/CONTACT PERSON: �� �--��✓�'
ADDRESS/PHONE:
PROPERTY LOCATION: �t� ���
MAP C'_ PARCEL: cmoo, 5—v ZONE �e /L.,_
THIS SECTION FOR-OFFICIAL USE ONLY:
PERNIIT APPLICATION CHECKLIST
ENCLOSED REQ1 ED DATE
ZONING FORM Vff.T,FD OUT
c: -- c/
Addition to Existing
ArresqntDjStrnrtnre
P�
2
Tfp freLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
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
/
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 Consery n Co ion
.-a- 0 12-.?
Signature of uilding for at
NOTE:Issuance of a zoning permit does not relieve an applicant's burden to comply with ail
zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
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