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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
40 APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location D/I W111 0 j Lot No.
2. Owners name Address Cop) i i Abk,) Ur,
3. Builder's name C Address p? cw,)MtnW �'
Mass.Construction Supervisor's License No. t',ZCLH 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 QG
11. Distance to lot lines E 3o' L yo f 2 atsi I a)
12. Type of roof -/13. Siding house r IJ,4�
14. Estimated cost:-
3�m��
The undersignowrtifies that the above statements are true to the best of his, her
knowledge d f. Zq---
/ Signature of responsible app icant
Zemarks I lop 1 �f_ (air, lc�LE'� svt J("f
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4�tv�MP�
m FEB 2 5 ,19%,19% DEPARTMENT OF BUILDING INSPECTIONS
J` 212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVTT
M C� 'V c1 N
(licenserJpermittee)
with a principal place of business/residence at:
J %Q! nte�i�' (phone#) -53
�
(Street/ci ty/stAdzi p)
do hereby certify, under the pains and penalties of perjury, that:
O I am an employer providing the following worker's compensation coverage for my
employees working 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) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (lnsurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(goad,additional sheet ifneocnary to inchsde k&armition pertaining to all oodraci )
I am a sole proprietor and have no one working for me.
( ) I am a home owner performing alI the work myself.
NOTE.,please be awam that whilo hcmeowoers who employ pc==to do mxj �conshixtioci or fir work on a dwetling of
not mom tbea throe units in wlrich the homwwmr midra or on 64 grounds appurtenant thereto arc not gwcrslly ooandercd to be
employers under the woe , oomp=at c n Ad(GL152,s 1(5)),application by a homeowner for a license or permd may-rcicnoe the
legal statue of an employer under the Workees Compen cation Act
I understand that a copy of this r femmt maybe forwarded to the Deportmcaa of Indaistrial A=&a&offroo of Iusursnoo for the
covcaxge vrsification and that failure to sea=mverap to dcr section 23A of MGL 152 can lead to the imposition of criminal Pe-16-
ooasistirtg of a fine of up to S1,500.00 and/or impr6omxwrd of up to one year and civil penalties in the form of a Stop Work Order and a
firm 0(5100.00 a day'p-sl ma
For dcpntm�use oaly
Permit Number
Mao #
Signature of Liccnsee/Permit tee
- l'a11:1T.
M
i
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 MAST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This column to be fill,,d in
by the Building Dcpnrtment
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - O
- side L: ('U R: 3 L: Ll 0 R: 3
- rear �0 q')
Building height )C" 1 jG I
Bldg Square footage PL1 O
%Open Space:
(Lot area minus bldg � I
&paced parking)
# of Parking Spaces Z
# '6f Loading Docks
Fill:
-(volume -& location)
13 . Certification: I hereby certify that the info oration contained herein
is true and accurate to the best of my know
_ � -
DATE: APPLICANT'S SIGNATURE
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with ail
zoning requirements and obtain all required permits from the Board of Health, Conservtation
Commission, Department of Public Works and other applicable permit granting authorities.
FILE #
FEB 2 5 08
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINTALL INFORMATION
1. Name of Applicant: �J 0" mlyx ct6nzl
r
Address: P9 av�7i�t- 4 Telephone:__
2. Owner of Property: kit"'�iicG.
Address: Ro"W' rr Telephone: �C/ owl
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): 1',C.
4. Job Location: Ek 1_ tic V 111-0 ^ C''S'V,C?L
r
Parcel Id: Zoning Map# Parcel# `� District(s):_. ��
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5, Existing Use of Structure/Property '4
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
--K
tk4 S�w ul'vl� 0 iilv-i
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—A_ 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)
R. FILE # 03 243 131q
£, < FM 2 5 1998
i;,APPLICANT/CONTACT PERSON:
ADDP.ESS/PHONE: 7 C'.-�4zxzlct—dj -
PROPERTY LOCATION: rl"-c P�'i2 ICS
MAP PARCEL: ( ZONES _.
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FULFT) OUT
Fee PAid
lRididing Permit Filled mit
FeePaid
r,
try
THE LLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATIOM
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 Conservation mission
z 17A
Signature of Building r Date
NOTE:lasuanoa of a zoning permit does not relieve an applioant's burden to oompty with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commisslon, Department of Publio Works and other applioable permit granting authoritles.
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