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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. �— Alterations
ti
NORTHAMPTON, MASS. ee2u /I. 19 Additions
' Repair
• ' APPLICATION FOR PERMIT TO ALTER
v Garage
1. Location r` rl���E /�,yE�� . Lot No.
2. Owner's names�y.�t// IGz-1 /�/C�2�-1/ Address Alt G�-r#, 1-7- -Wi-j
3. Builder's name Al Irh' dt�Z c�TOmi Address d 65 ®
Mass.Construction S pervisor's License No. /?.- ' �`Sr 6 _Expiration Date i
4. Addition
5. Alteration
6. New Porch
7. Is existing building to be demoli ?
8. Repair after the fire
9. Garage Z-4 X 2- w G .Alt Alf LT No.of cars Z Size j6� �/�,�Ls>�t' Z3c�CA2
10. Method of heating
11. Distance to lot lines 1-D U& Z66 r el*U,1-1 &A-7-) � � '� Id
12. Type of roof J21;?-
13. Siding house L
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
kn w dge d belie
Signature of responsible appicani
Remarks
�Tt1AMp�,
�a3frrCElnfetlf
,
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(li ttee)
with a principal place of business/resl ence at:
(phone#)°1,5 23t'_
(strceVcity/statelup) 6110 d
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 Comfy) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the cant;acto„ h-ed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compary/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach a kHoml sbeet ifnecenary to iac}ude informafioa pa�to a c.'radon)
(>4 1 am a sole proprietor and have no one working for me.
( ) 1 am a home owner performing all the work myself.
NOTE:pleas be awa.^e t xiylc iscowzx s W employ pcmoea to do m inn n c c=sauctioe or repair work on a dwelling of
not More than three units is which the homeowner resides or oa the grouads appurt=A tberdo are not gcocrally ooandered to be
employers under the worica`a.ration Art(GL152,ss 1(5A application by a homeowner for a license or permit may evidence the
legal etatua of an employer under the Wodroes Compemation Act
I understand that a copy of this statement may be forwarded to rho Dcpnrtmca2 of Industrial Aaadea&Ofoc of Iawraneo for the
coverage verification and that failure to secure coverago under secUoa 25A of MOL 152 can lead to the imposition of eriminal peaalties
000sisting of a fine of up to 11,500.00 and/or imprt� of up to one year and civil penalties in the form of a Stop Work Order and a
firm of 5100.00 a day against me.
J
Signed zsN y of 1997 For dal use only
Permit Number
Lot#E
Si of Licensee/Permittee
10. Do an signs exist on the property? YES NO
Y . j .
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.
This column to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage Soo
Setbacks
- side L: R: L:/-O$ ] R: ZI
- rear i s--fi
Building height 2-Y FEET
Bldg Square footage -762- X-4 '
%Open Space:
(Lot area minus bldg
' &paved parking) �J3
r
# .pf -Parking Spaces 3
fof Loading Docks
Fill:
vol-ume--& location) D
13 . Certification: I hereby certify that the inform tion contained herein
is tru an accurate to the best of my kn wled Pte_
1
DATE: �-Z-t.� APPLICANT's SIGNATURE
NOTE: lae(jancaf of a zoning permit does not relieve an IfoanYs burden to oom wit
P PAY h,.pll-:.
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commisslon, Department of Publio Works and other applionble permit granting authoritle .:..
FILE #
i1 �
b
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: '
Address: e4 E -�
�7 A a;f Telephone.
2. Owner of Property:_ —z��&C
Address: 1,31 Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# Parcel# District(s): ),
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property Sy7EL
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 PermitNadance/Finding ever been issued for/on the site?
NO Vd f 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)
.'yam
FILE I :16 7
MAY 2 1097
APPLICANT/CONTACT PERSON:
DDRESafPHONE: �ti� Qf —� p
PROPERTY LOCATION: / Q _ /Cjt�t
MAP PARCEL: ZO
THIS SECTION FOR-OFFICIAL USE ONLY:
PERNUT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM EITLED OUT
Fee Pnid
IR11i ding Permit Filled njit
Additinn to Vykfin2 k)
Striyrfiirl
�!! 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 Conservation mmission
Signature of Building ffiskvlo—r Da
NOTE:Issuance of to 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.
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