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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
a Garage
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
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1. Location ,3 ) l/t�� Lot No.
2. Owner's name [� Address 1�
3. Builder's name_ /. a Address et4z, AJ
Mass.Construction Supervisor's License No. 0/ 7 6/c�- Expiration Date /0— -2 y --
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
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost- 7�(
J The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible app,tcant
Remarks
�gHAMp�,
9 0 o R rx� of Wart4amptan Z I
$
NOV 7199tassarf<ttsrtta
�. DEPARTMENT OF BUILDING INSPECTIONS '
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORMERS COMPENSATION INSURANCE AFFInAVTT
L �G' Jy
Oicenseelpelmittee)
with a principal place of business/residence at:
(phone#) 4 6 '/ -7 9
(street/city/state/up)
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 Company/Policy Number) (Expiration Date)
(Name of Contractor) (insurance Company/Policy Number) (Expiration Date)
(Name of Comracttor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheet if necessary to nwhx a information pfttu ng to all oomrectm)
Iam a sole proprietor and have no one worldng for me.
( } I am a home owner performing all the work myself.
NOTE:please be aware that while homeowners who employ persons to do maiotmaacr,congruotionor repair work on a dwelling of
not more than throe units in which the homeowner resides or an the grounds gvudenarrt thereto are not gaaeaaily considered to be
employers under the wurkeez compensation Act(GL152,ss 1(5))�application by a homeowner for a Gcem or permit may evidence tho
legal status of an employer under the Worker's Compensation Ad.
I undemaad that a copy of this statement may be forwarded to the Depertarmt of Industrial AccidealY Offios of Insurance for the
coverage verification and that failure to smire coverage under section 25A of MGL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to$1,300.00 and/or of up to one year and civil pemdties in the form of a Stop Work Order and a
fine of 5100.00 a day agaiva me.
Signed this day of 1995 For depaatntental Use only
Permit Number
Map# Lot#
Signature of Licensee/Permittee \
See reverse side fnr ingtmetinns \
r
10. Do any signs exist on the property? YES NO /f
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 COMPLE'T'ED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This comma to be filled is
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks -frnnt
- side L• R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
Lot area minus bldg
&paved parking)
_pf _Parking Spaces
# rof Loading Docks
Fill:
4vo1Ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: l l— `� ? APPLICANT's SIGNATURE
NOTE: lauumnoe of a zoning permit does not relieve an a lioanta burden to oom wit
PP ' Phi
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of public, Works and other applioable permit granting authoritiea::.
. ,';r FILE #
w
NOV 71997
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: / - / Telephone:
2. Owner of Property: �,�f2
Address: elephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: x .33
7 i , �i✓i'Zr`r
Parcel Id: Zoning Map# L7s!,)�- Parcel# '� � District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
S. Existing Use of Structure/Property
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 - 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)
FILE 1_ 8 P �*�i�
�. / I
NOV 71997
APPLICANT/CONTACT PERSO � ,
ADDRESS/PHONE: c�
PROPERTY LOCATION: 03 2a
MAP- fL- PARCEL: aONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
7,0NTNG FORM MIXT) OUT
Fee Paid
Fee PAid
Remodeling Tnterinr
Addition te Existing
T�,,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 Consery Commi 'on
Signature of ec
Buildin tor Date
NOTE:lasuanoe of a zoning permit does not relieve an applloant's burden to oompty with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commisslon, Department of Public), Works and other applioable permit granting authorltles.
City of Northampton REQUIRED INSPECTIONS
BUILDING DEPARTMENT 1. Footings and Walls
2. Structural Components in Place*
I Complete Building*
No. 1081 Office of the Building Inspector
Zoning Form No. 963002 Date 11/7/97 Fee 520.00 Check# 3747
Page, 25C Parcel 49 ,Zone URB Section 127 ❑ Yes ® No
BUI]LDINGPERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT D A Williams before Building Inspections
has permission to strip & shingle porch roof Inspection on Site—Foundations
situated on 233 North St - E Zebrowski Inspection of Plumbing—Rough
provided that the person accepting this pernut shall in every respect Inspection of Plumbing—Finish
conform to the terms of the application on file in this office, and to the Gas Inspection
provisions of the Statutes and the Ordinances relating to the Construction, Inspection of Wiring—Rough
Maintenance and Inspection of Buildings in the City of Northampton.
Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring—Finish
of this permit.Expires six months from date of issuance,if not started. Building Inspection—Rough
Note:A certificate of occupancy will be issued by this office upon return Insulation Inspection
of this card signed by the Plumbing,Wiring and Building Inspectors. Building Inspection—Finish
** Install per Manufacturer's information: windows,vinyl siding,roofs Smoke Detectors(Fire Department)
and woodstoves
Other
s
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON T PREMISES
Certificate of Occupancy
u Inspector