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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. -�-3 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location J`J� ^- /'�J � �' Lot No.
2. Owner's nam � �/� 1 %/�/��1/��° 1Q )2/ 1���,fl t Address_YD�J/�,��'�/v!k `�
3. Builder'sname/�IQ��C�/i LJ./� , J /V� 44-WrW A ddressy
Mass.Construction Supervisor's License No. 105Y3 0140-3T Expiration Date yrf'
4. Addition l
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- ^ 0 f 0L
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible app�icant
Remarks /L � // .�'f' U��.� — AfJ
Crit� of wortljttntptou
9 B �i:ssacilttsctts
� n
MAY 2 2 1997 DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, Nelson A. / valley Home Improvement, Inc.
(licensee/permittee)
with a principal place of business/residence at:
320 Riverside Drive Northampton, MA 01060 (phone#) (413) 584-7522
4
(strert/ci ty/statc/zi p)
do hereby certify, under the pains and penalties of perjury, that:
M I am an employer providing the following worker's compensation coverage for my
employees working on this job:
Eastern Casualty Ins. Co. WC9660047 2/1/98
(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) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (E)piration Date)
(auach additiocal aboet if necessary to include information pertaining to all ooahaeWrs)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aw+=that wbile homeowom who employ pa=ns to do maialmamcr,ooniwction or repair work on a dwelling of
not mote than throe units in which the bomeowner resides or on the grounds appurtenant thereto art not gaocrally oomidered to be
employers under the vmrkces compensation Act(GL152,s 1(5)�application by a homeowner for a license or permit may evidenoe the
legal status of an employer under the Workee a Compensation Act
I understand that a oopy of thin eiatement maybe fwwwded to the Department of Industrial Aeadm&Offioe of Insuranoe for the
cover&W verification and that failure to socure coverage under section 25A of MOL 152 can lead to the imposition of criminal penaltitS
comistting of a fine of up to$1,300.00 and/or imprison of up to one yt u and civil penalties in the form of a Stop Work Order and a
fine of 3100.00 a day against ine.
Signed this _day of XW 1997 For dial use only
r Permit Number
741 f'✓v�• Mao IAi t�
Signature of Lice;9(dePermiltee
z
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.
Th.�L: cow to be tilled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
R,
c
Frontage
Setbacks
- side L: R:�
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
-Parking Spaces
fof 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 knowledge.
DATE: -��3�'`� / APPLICANT'S SIGNATURE � '` ��tr� ✓�
NOTE: Issuanoe of a zoning
g permit does not relieve an appii Ys burden to comply_witt�,,a�l
zoning requirements and obtain all required permits from they Board of Health. Conservation
Commission, Department of Publio Works and other applloable permit granting kuthgrities, --
`:' ,, FILE #
L
File No.
MM 2 21997
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:1Jz4J1, Y .,�,F-,T
Address: SOX 66N 7 -,;W Telephone:
2. Owner of Property:
Address: /U /' • N Telephone: 4c-11 6T 7
3. Status of Applicant: Owner / Contract Purchaser Lessee
Other(explain):___(
4. Job Location: 4&ua
r
Parcel ld: Zoning Map# 4� Parcel# & � District(s):,,��, /� ✓�
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property Jl'L / 1x�7lLSl
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 y 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 t,—' 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 FILE # i} J 3 445`1
MAY 2 21997
APPLICANT/CONTACT PERSON: 75-
ADDRESS/PHONE:
PROPERTY LOCATION:
MA? PARCEL: 1d ZONE_W,?
THIS SECTION FOR-OFFICIAL USE ONLY:
PERNIIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM ITHLED OUT
Fee Pnid
1311i ding Permit Filled.nilt
Addition to Exiqtin2
t.
!a C "
�x sets
THE LLOWING 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 Conservation Gnmmission
x 9
Signature of Building r Date
NOTE: lssuanoa of a zoning permit does not relieve an applioant'a burden to oomply with all
zoning requirements and obtain all required permits from the Board of Haaith, Conservation
Commisalon, Department of Public Works and other applicable- permit granting authoritles.
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