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25C-049 (3) z � T A r— D •J �• D t` O to s -s Z � z = �, -� m r 0 Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations a Garage NORTHAMPTON, MASS. 19 Additions APPLICATION FOR PERMIT TO ALTER Repair ��11,, 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