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36-109 (2) w > z LU �. 1 w , Z m Z > _ O Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 4L Limit 3 U Alterations NORTHAMPTON, MASS. Y Z.? 19'7 Additions APPLICATION FOR PERMIT TO ALTER Repair a Garage 1. Location .237 Lot No. 2. Owner's �/u.�E ;��✓,wc; Address 3% &'%fk5iae Clzctag Al rc•✓ 3. Builder's name Address 5! Cck✓.,J'Y Z-) iv.�n14-T�-v Mass.Construction Supervisor's License No. 6UQ k Expiration Date 4. Addition�3/� - /z/ A �2 6 r A14v 5. Alteration A114 6. New Porch 7. Is existing building to be demolished? .VA 8. Repair after the fire ir114 9. Garage ,u6r No.of cars Size 10. Method of heating K.4 s .mac,_ 11. Distance to la lines /— d;�� z3,' - .•lac ~ E' � Tu T . 12. Type of roof ,� -'i<�s r s' fi.✓ S 13. Siding house 14. Estimated cost-� The undersigned certifies that the above statements are true to the best of his, her knowledge and belief. Signal responsible appicanl Remarks Grit r of Nart4antpton X � 2 219!97 ..,1� ,�lasaachnsrtta „lDEP�RTMENT OF BUILDING INSPECTIONS -un1�F Y' X21 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKEWS COMPENSATION INSURANCE AFFIDAVIT (li censer./permi ttee) with a principal place of business/residence at: 1A ///I r's�; f>/l (phone#) (street/city/state/zip) do hereby certify, under the pains and penalties of perjury, that: ( ) 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) (Insurance Comparry/Poliey Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional sheet ifneassuy to include information pertaining to all contractor,) 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 aware that while homeowneta who employ persons to do mai„r.,,a„M orals ion or repair work on a dwelling of not mote than throe units is which the homeowner resides or on the grounds appuexannt thacdo are not generally ooandered to be employers under the worker's compens4m Art(GL152,ss 10)),application by a homeowner for a liocnw or permit may evidence the legal status of as employer under the Woriceez Compamation Act I understand data copy of this aiatcment may be forwarded to tbo Depwtmrn of Industrial Accidea&Offioe of Iuvausace for the coverage wrificatioa and that failure to secure ooverago under socdoa 25A of MGL 152 can lead to the impo oa of criminal penalties oousisting of a fine of up to$1,500.00 andlor impr i o�of up to one year and civil penalties in the form of a stop Work Orris and a fins o(3100.00 a day agaitut me. Signed this' dzy of , 199 7 Ford use only �,/� Permit Number Lot# Signature of Li ermittee N ;a r DSO � n r� r i1 1 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 N0_2�_ IF YES,describe size,type and location: 11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. This cols to be filled in by the Building Department Required Existing Proposed By Zoning Lot size Frontage Setbacks d a' 3 - side L: k6 R: ,' L: dC R: 7/ j !� - rear j0U 0 Building height f s 7U,<1 35 Bldg Square footage %Open Space: (Lot area minus bldg 0 � &p?ved parking) S 1 d0l 40 SQ /GT # :of Parking Spaces i� of Loading Docks Fill: 4vol-ume--& location) 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. _1 DME: IVA y � ��y'r APPLICANT's SIGNATURE �- t'' NOTE: Issuance of ai zoning permit does not relieve an a iioants urden to m PP Ply_with,,ptl- zoning requirements and obtain all required permits from the Board of Health. Conservation Commission. Department of Publio Works and other applloable permit granting authorities. FILE # �'� P f., MAY 1 51997 EPTOf File No. ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: Address: �.3ov,�;y .C',� ,/2,,,. _ elephone: 2. Owner of Property: .5q Address: ,:23Y CoecF Telephone: 3. Status of Applicant: Owner —Z--Contract Purchaser Lessee Other(explain): 4. Job Location: .,?oo, 5,zw- Parcel Id: Zoning Map# Parcel# District(s): (TO BE FILLED IN BY THE BUILDING DEPARTMENTY 5. Existing Use of Structure/Property A 211f_:.:7.al_ 6. Description ofProsed Use/Work/Project/Occupation: (Use additional sheets if necessary): fy� ,4i�i��>->o� �.�- .n /s�,r�L ` .era g rh-.r r��,c'n�,•.! �,� � ��,�rz, ��.E /1J'ri9C.- sCi7 2/.ay ) /I— T/-/cF r✓�-r;�-aC y% f.✓y ©F '77—E /fc�r9�fi t�✓�T/1 r=[/cL' __ �.✓.9�tt' CJC--+r i�°ASF�.�f.�s.J�� ,-'c�i�. "_2v o'_ 57rsC'weqc- 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) �! r FILE # 965 4 IM1Y 51997 APPLICANT/C NTACT PERSON: 7"Q�2_-t O p BANE ` `> PROPERTY LOCATION: ? MAP PARCEL: ZONE �� THIS SECTION FOR.-OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZQNINC�FORM M.I.E.1) OUT Fee pnid New Cnmqtrnrtinn C� 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 ermit from Cons do fission /2-177 Signature of Buil ector Date NOTE:Issuanoe of at zoning permit does not relieve an applioant's burden to oomply with all zoning requirements and obtain ell required permits from the Board of Health, Conservation Commission, Department of Publio Works and other applioabie permit granting authorities. s o Lo O O ,� ��' ms `s•�< �• < �-*� < a •� VI . 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