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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. /X-M 2:�d I gly Additions
• I Repair
APPLICATION FOR PERMIT TO ALTER Garage
1. Location ✓✓0 0), /)/Arr S Ala?P,to k,-P-rG fil Lot No.
2. Owner's name F 6 Address //0 UJI1,4kn-5 5r
3. Builder's name Address P W/ 41ee 4
j7e
Mass.Construction Supervisor's License 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 15,i 42
14. Estimated cost-1 -, od t)
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible app icant
Remarks
R .f•, r
0�
9 8 3 ati711t�7CTTT
a MAY 1 5
'998 AIX 55 tttyttsclla
DEPARTMENT OF BUILZ)rNG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060 ~y
WORKER'S COMPENSATION INSURANCE AF IAVTT
(licenseclpermitzee>
with a principal place of businesslresidence at:
'P �e �An 4/0R4A +,. (phone#)
T
(strmt/city/ zip)
do hereby certify, under the pains and penalties of pegury, that:
(/am an employer providing the following workers compensation coverage for my
employees working on this job:
(Lnsumnce 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/Policy Number) (Expimaon Date)
(Name of COLILM,ctor) (Lasur-'mcc Compau)'[Poticy Number) (ExTLmuon Date)
(Name of Contractor) aDsuranc,� Compaay/Pokcy Number) (Expiration Dale)
(Name of Contractor) (lnstuance Company/Pollcy Number) (Expiration Date)
(attach additionzl sheet ifncCcs tD inchuie rotor ti on pcztaining w all ooamn f-3)
( ) I and 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 wkilo homcrnwcra wbo employ p,,Om w do ird�coasruction'ar repair work on a dwelling of
not nx"than throo units is which the bomoowua resides or oo tho OF tujds appurtenant thudo,,m not generally oowidcrrd to be
cmPloy—under tho worker`s oompcn 4cc,Act(GL152,s l(5)�applica.6ou by a homcowncs far a lick a Pa-d=Y c idc� tho
Icgal statul of an omployoc undortho Wockc ez Compcma6cn Act
I undcratand th,t a copy of this cratemcrd may bo forwardod to tbo Dcyai�of lodautri d Attad—'moo of IaVMT o0o for tbo
covemgc verifieatioo and that fallurc to&.carte coves-mv under soctiOct 25A Of MG 152 can lead to tbo'imPo'¢'on of aiminal penalties
coavistutg of a fine of uP to S1,500.00 and/or imprison of up to one year and civil pcnaltia in the form of a Stop Work order and a
find of 5100.00 a day agpinsi ti-
FCC dq=wxr:bj trio Daly
Permit Number
_�--Lot#
�., Sigpahuc ofLic=sccJPermi -------�
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 COMPLE'T'ED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This colu= to be filled in
by the Building Dep&r nt
Required
Existing Proposed By Zoning
I Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&Peved parking)
# of -Parking Spaces
# of Loading Docks
Fill:
4 volume-& location)
13 . Certification: I hereby certify that the information contained herein
G a is true and accurate to the best of my knowledge.
_
DATE: ld",j7a,!7 5,,? APPLICANT's SIGNATURE �- �c�
NOTE: lasuan a of a zoning permit does not relieve an applioant's burden t oompiy with-4111
zoning requiraments and obtain all required permits from the Board of Health, conservo,tion
commission, Department of Publio Works and other applicable permit granting authorities.
FILE #
.r
MAY ( 5 L%8 File NO. 3
rPT c , ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: 7�i1 16P-141,1' Alia Ar-11 4^ k) 04telephone:
L. Owner of Property:-
Address: �/0 Pf»�5 � I�'G��if9v.�rU� "elephone:
3. Status of Applicant: Owner �Contract Purchaser Lessee
Other(explain):
4. ,lob Location:
Parcel Id: Zonin g Ma #
p --�3�e Parcel# ;;TY District(s��.�'
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property t� LaT1.' lu
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)
FILE # (!
A1` Wr/CONTACT PERSON:,
� t1DDRESS/PEDONE: 7tro <
TPROPRT'Y LOCATION:
MAP PARCEL: ZONE ��
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION_CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FH,T,FD OUT
Fee Paid
13nilding Permit Filled mit
Fee PAid
lype of Construction-
New Cnnqtriirtinn
c
THF,FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
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 Conservati otnmissio
Signature of Building ector Date
NOTE:Issuance of a zoning permit does not relieve an applicant's burden to comply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authorities.