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36-232 (3) � N i M �I ' j C i i n� 7: a cn Z m C4 Z Z Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 6J 2- 0 3 Alterations NORTHAMPTON, MASS. I fz6 A /?9 Additions APPLICATION FOR PERMIT TO ALTER Repair D Garage U I. Location �� t a rvt n 1anV r f-I�6 1�1c ✓u� Lot No. 2. Owner's name MI rrm I�eItt1 Address %:4- Ur .Leo,cc. Lyv 3. Buildcrsname R0-61eoi Address ICS Qg.. � S f e Jo��� uA�itr /"�D�DtfSfj� Mass.Construction Supervisor's License No. Q- y 3 L� Expiration Date 4. Addition I /, I 5. Alteration T o C orur��h are-ct U,�tlL&e Car�ac et.e ;VA0 rp et^ i3e�& rPn,H c���' � t�vll at T�r.����,. ��C"i en�c' 6X, Sf0-5 00omer w bock &)Fhaos 7a 5le.e. t•t, :X�9�,••S �4• Se r�«>r� 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 01 l 4 li® � cum e-w 11. Distance to lot lines— Fen, K c c r i osa L 12. Type of roof V^00 �.� S D ,t 13. Siding house V l w l ce 14. Estimated cost- 35 $u-Sl, G� The undersigned certifies that the above statements are true to the best of his, her knowledge and belief. ?AMA Luy-�,, Signature of responsible app scant Remarks t r � lixt 6199 f w 020 s W w 7 0 C N }r0 f' r I �l A ( 2r W Cp p kA �b C, Sr- e i t�•n G�� I � I �) n I _ ... -- =r Sk -_ w 9-1 I LP n;,t r Z � s a G a 9-7 (� p CAJ I ' i I 1 a K — -� tr Crzk of Xor tt amptan r `1`Y 6 1997 $ � �`'t 7 �tassatchttsrtfs � � c DEPARTMENT OF BUILDING INSPECTIONS f 212 Main Street « Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT ai^rte (licensee/permittee) with a principal place of business/residence at: J'R<; t o 7 3 (phone#) (streedcity/stafe/2ip) do hereby certify, under the pains and penalties of pedury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: (ft usance Company) (Policy Number) (Expiration Date) ( ) am a sole dst ety , general contractor or homeowner(circle one) and have hired the contractors Blow wh o have the following worker's compensation policies: litav�e vi�o� �trt? ('40� SU� C o4,. cc,C C,� fitii5 f� � (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) (Expiration Date) (attach additional shed if neoessary to include infonmtion peetaiuing to all ooatractors) (X} 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 homeowners who employ persons to do T+*■mten+nce,construction or repair work on a dwelling of not mote than three units in which the homeowner resides or on the grounds apptutanant therdD are not generally considered to be employias under the worker's compensation Ad(GL152M 1(5)),application by a homeowner for a license or permit may evidence the legal status of an employer under the Workeez Compensation Act I understand that a copy of this statement may be forwarded to the Depeumrent of industrial Aocidearts'Office of Insurance for the coverage verification and that failure to seatre covornge under section 25A of MGL 152 can lead to the imposition of criminal pemltias consisting of a fine of up to 51,500.00 andlor imprisonment of up to one year and civil penalties in the form of a Stop Worst Order and a f»m of 5100.00 a day against tire. Signed this _____day of_ffiq Ci 1997 For anal use only J Permit Number I�( Map# Lot# Signature of LicenseelPerinittee See reverse side for instntctithnv 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 DOE TO LACK OF INFORMATION. This cols to be filled in by the Building Department Required Existing Proposed By Zoning Lot size U) Frontage Id Setbacks ` ` v - side L: ��� R: �d` L: a�6` R: S�a - rear Building height Bldg Square footage 7 / q A_ j %Open Space: (Lot area minus bldg ' &paved parking) of Parking Spaces # 'of 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: =F1 / �,7 APPLICANT's SIGNATURE ?" NOTE: Issuanoe of a zoning permit does not relieve an applioanYs burden to oomply wit 11,,all zoning requirements and obtain all required permits from the Board of Health, Conaervtation Commission, Department of Publio Works and other applicable permit granting authorities. FILE # Mfi 6 1997 °���' File No ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: e o�e- ` l nrr t er Address: I (o k!Q I 5 So J(,Q r..,o 1 G w Telephone: _ J d 3 3 2. Owner of Property:_ I jCa -ka A K e Address: C4weercj Occx,,,J Telephone: S8'6 3 47 3 (p 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): 4. Job Location: v r Parcel Id: Zoning Map#�_ Parcel# v'3 District(s): ` (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property, 6. Description of Pro osed Use/Work/Project/Occupation: (Use additional sheets if necessary): 6 eb►vv'eg Q y'ea n& C .e gee~q:sL 6kAd 414!j4Q, Se�"O" '�`k f1 17,n 1 5!:Z1'Q ellts�149 Ony1w.*r try �Qc.k A f 4-6 1e.tj ti t t 4 t" 7. Attached Plans: X 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 PermitA/ariance/Finding ever been issued for/on the site? NO DON'T KNOltit�_ 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 9 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 # 7 ` � fL MAPPLIICANT/CONTACT P RSON; �", � 0A33 ADDRESS/PHONE: 16 `7' JF PROPERTY LOCATION: C e MAP ���`p PARCEL: ZONE �2 THIS SECTION FOR-OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM EITLED OUT Fee Pnid ]Rnildin2 Permit Filled ()nt Feepnifj T 1 d1,- New Cnn,�trurfin c' Ownpr/Orrzipnnt Statement nilicengpiff 1'5L THE LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION- 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 Commission S �n Signature of Building ector Date NOTE:Issuanoa of is zoning permit does not relieve an applioant's burden to oomply with all zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Department of Publio Works and other applioabie permit granting authoritles. co CD 0 o 00 c, Yo ° o a ° a ° Gr. c •a.m•� �• r* ° M cn co 0- 0' O s � N O V1 N Ddb ►-3 c ° o+ CD b b � � g n0 qQ E � g � rt w0 3 0 rt l 1 _ g � '� 0 p Q 8 - , : °" mo o. ° d z coo CA ri) n wd o y � 000' ww: z r 0 s s s rum tz y y a 0 0.o boo � ° �. ul M (IQ N y \ S °� � Q G cCCC NI a I' a Ci7 w N ►d� ° s qQ 7Q tom" OQ �(IQ ° � (' cn 71 0 5 08 0 o l � 0 n m o o ° --_- .._...=w�..��- �. � �: .. �. ,. �,� r � r, i � � - .x .. � � .a.. _.. 3 c R. o �. 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