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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No, Alterations
NORTHAMPTON, MASS._�,�"� 2 19� Additions
' APPLICATION FOR PERMIT TO ALTER Repair
Garage
I. Location ( sf �/�i�� � aJ'�%T. Lot No.
2. Owner's name '�/!�'�� Address _ �� �G'�` �f/ ;S7:
s 3
3. Builder's name Lc' T- 7ZSc�llll� Address �_' /� �� ✓��.SC✓U � L12�
Mass.Construction Supervisor's License No. Expiration Date
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. Estimate cost:-/
The undersigned certifies ve statements are true to the best of his. her
✓ know,ledge- ieT f
Signature of responsible app icanl
Remarks
t
(riff tof 'Ntoxfllalltpton
P97 �i:ssnc}fnsclls
E OF BUILD' _ DEP tRTMENT OF BUILDDIC INSPECTIONS
212 Main Street ' Municipal BudcEng
Northampton, Mass. 01060
W0RICER'S Coi[YeJNSATION INSU _NCE t ' AVTI'
(li ink-J[xrmi tl::_>
r,th a. prin(:�Ipal place of buSw,-sslresideoce tit:
do hereby ccrti'y, under �hc pz,ns and pe0116es of perjury,
( I am an employer proyldEl�g Llie following \vor'cc s c001Dcns�uon covemoc [or My
employees worming on this job.
(Insurance Company) (Policy Number) (Fxpil-a6ou Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the followimg workers compensation poGcics:
(Ncmc of Conlncwr) (Insurance ComVaji}'/PoUcy Numb-r) (EXp Intio❑ Datc)
(Name of Contractor) (LnsZlrancz- Compadly/?OGc/Num�cr) (Expiration D�e)
(N= of Contractor) ([nsuranc� Corup m,/Pol c/ 17 ilea} (Expiration Datc)
(Nzounc of Contractor) — --(I_asura.nc Coropa>y/Policf Nuns r) (Expiration Date)
(.n �h�Gditiowl c5.-ct if oc�a,ry co c:.\:6�iafcKmij co pc'-hang to.11 cc�.r-1'on)
O I am a sole proprietor anal have no one worEog for me.
O I am a'home o4vner perol-mino all the work myself.
NOTE_plczsc be aWruc chd vjxj)a %�txa ccaploy pc"cm to& Cr or
acs mc,�'c th---.•a tbroo waits in,,{ ct,tI�,- cc cn LS-Rcun :pputtn t[tk;ctn uc oct Ecr>--Sy coy^uc:c�1 to t<
-uQloym under th-wc�,orc--�co/.ct(G try c 6ocrowo s Im-a l crux cc porn t msy cv L 5e
ICg.[It-At..of m c-mp[oy«under tbo WOI4Ie.Compom+L oa Act'
I undcrztrnd tb-xt a copy of lhi.cat—.•-Y Cv forwarc'.>d w tbo Dc.?u>rxat of 1�1u zl-i d of tu-u,—for L".
co-rr&c vcri c=t.ioo sad tb.t Gi!urc to rcaL-c co�rrago vadcr icdi a 23A or 1.tOL 132 cia lctd to tbd impazit:co of crimi-��a-1 ict
oomisiiuq of x five tttzQ to 51 00,00�/« mpruocux�t orup to 0o ycr ind c vd pc alto in the roan oCn stop\'lock.O�',cr end
find oC S 10o.0o d3:y LpluA.me
Signcc�-'tli �' f f y �G GG r 199 7 FO,&cp� Oaly
Permit Numbcr
2 Map f Lot t!
Sig)la of Liccnscc/t'crmitYrx
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 colu= to be Pilled 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
&paged parking)
# �f Parking Spaces
# of Loading Docks
Fill:
4 vol-ume -& location)
13 . Certification: I hereby certify that the information co tained herein
is true and accurate to the best of my ed
_j r.
DATE: �lZ � APPLICANT's SIGNATURE
NOTE: Iss nu oa o of a zoning
g permit does not relieve an pplioanYs burden to comply wlt ,,$II
zoning requirements and obtain all required permits f m the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
11 NOV 2 1 1997
1D FT OF BUILD, -- File No.q4',-5
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE E OR PRINT ALL INFORMATION
1. Name of Applicant:
Address:_/ f t�I�A,�g�P Sr1�1?S�i �f/l,(%�' Telephone: f je,S - - -- —E
2. Owner of Property: � ;/, -;� �e`,C/ ': (.'�c� JTL e JC'/Tr --
Address: Telephone:
-,2 S/ �>
3. Status of Applicant: Owner Contract Purchaser Lessee
11 Other(explain): ( �'LUIL� ✓ ✓��'- ,T%C- ,
4. Job Location '—
Parcel Id: Zoning Map# c3 Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
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)
L5 U U FILE # " a l`f 2
---.� 0
�►�y 2 1997
APPLICANT/CONTACT PERSON: oZ�'�
,FS`/PHONE:
PROPERTY LOCATION: � d
7LQ.�iI1
MAPS PARCEL: Z
THIS SECTION FOR-0FFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONTNG FORM EITLED OUT
Fee Plifi
-3 Sets f Plnn
C? t/
4
T OLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
s 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
Pe it from Cons �a C on p
Signature of Building Wector Date
NOTE: issuanoa of es zoning permit does not relieve an applioant's burden to comply with all
zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authorlties.
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