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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. , ?3 / Alterations
NORTHAMPTON, MASS. .1, faaC ',-? Id 19- Additions
a APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location /� % Lot No.
2. Owner's name ,IdL M-N-U a: S'cs u ti 2ls Address 38 UN ecv nl gv`, . N '-tanf
3. Builder's name Pkit' 'i Address (atQ eAcZ St-
Mass.Construction Supervisor's License No. (0,�7LY Expiration Date ITIt.
4. Addition -- �/
5. Alteration .�(26 Silike 8! ✓-02 �1e�`rr �-- yd e b
6. New Porch
7. Is existing building to be demolished? 1(O
8. Repair after the fire ti10
9. Garage ''Nb No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof ai ex-17-
13. Siding house
14. Estimated cost:- �Sba c,V
The undersigned certifies that the abov to is are we to the best of his, her
knowledge and belief.
Signature of reVIOWIble app,icant
Remarks iP /ZU C LtI4 t'12 " COY, j2l�V & 2 lot) i
B B U�� �xsaxcE[nsctta
m DEPARTMENT OF BUILDrXG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WOR=R'S COMPENSATION INSURANCE AFFIDAVIT
�, 6f�11/ ��E�oy(.uz12•�
(licensee/permittee}
with a principal place of business/residence at:
3Q Q(go ST,7UV::1- iV r11(1z hone#) L5!;17-.33-,3
(strr✓et/city/stair/yip)
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)
(�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 Compary/Poricy Number) iration Date)
(Name of Contractor) (Insurance Company/Po[i(::y Number) (Expiration Date)
(Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (E)#ration Date)
(attach additioazi shoot ifncx s to inchsdt infornuiioa pextniaing to all o.ft dom)
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 paso=to do mxi• oomtr on-Cr repair work on a dwelling of
not morn than three units in which the bomoowucr resides or on the grounds appurtenant tbaeto arc not gcncrany ooasidcred to be
employeta under the weckees eompassaiion Act(GLI52-m 1(5)),application by a homeowner for a license a prsmit may cvidcaoe tho
legal ctatuo of an employee under the Workces convtauiion Act
I twdereAnd that a copy of this uatemeal may be forwartW to tbo Dtpartmco2 of lmlwhid Aecidca&OfEoo of Insurance for the
coverage vcrifieatioa and that failure to secure covcmgo under section 2 5 A of MOL 152 as lead to tbd impositioa of erimi pcaa cs
oomisIIng of x'fmc of up to S 1,500.00 andloe of tip to one year and civil pcml6a in the-form of x Stop Work Orxkr and a
fine of 3100.00 a day xgainxt me
Signed this day of 997 For&PUtocatal—cagy
Permit Number
WO Lot#
rgnatttre of i � crrsit
;.
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 DUE TO
LACK OF INFORMATION.
This columm to be filled in
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]
# of Parking Spaces
#
of Loading Docks
Fill:
-(Volume -& location)
13 . Certification: I hereby certify that the information 4ant. ned he ein
G is true and accurate to the best of my kno ledge.
DATE: y2 APPLICANT's SIGNATURE
NOTE: lss anno�a zoning permit does not relieve an applicant's ompl y 11
zoning requirements and obtain all required permits from the Board of Health, Conservtation
Commission, Department of Publlo Works and other appiloable permit granting authorities.
FILE #
0 1 d 1V
Fi 1 e No. 9x (//
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: �&Ia6 C-a62�4rvl'Vw
1 - _
Address: CP ,t T S Tom) 6 )OZ7 Telephone: ,5-22-, Z j
1 Owner of Property: 6wL M tC t l�- �C U�if2S c
Address: mcrx A t%,,- lmCj Telephone: 4�fl b/-j7-
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): e-pk ,s ,ZcK
4. Job Location: 2q4 &e 1'3�c
Parcel Id: Zoning Map# d'5 Parcel#_ District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property s�Aa�t,C
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
7i�?/ Y2 G►�,�[ P<Y DUf-.c' 2,CY'�G y c1t
I+mss sue[ .c) fMffi44rGT 4 in/S(g: :j Z�:e)P, ,*-L r f►1,0 e I
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.
S. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOA' 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 #
OFC 1 01997
APPLICANT/CONTACT PERSON:
ADDRESSIPHONE: &
PROPERTY LOCATION: ?
MAP e PARCEL:- ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Pnid
Fee Pnid
Type nf Construction-
Addition toExisting 14
of Plans / Plot P -in
l'
T OLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATIOM
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 Cons ry tion Comm' i
�,�� / i 9
Signature of Building Inspect Date
NOTE: Issuanoe of a zoning permit does not relieve an applioant's burden to oompty with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Pubiio Works and other npplioable permit granting authorities.
��°�'-�y City of Northampton REQUIRED INSPECTIONS
e 1. Footings and Walls
BUILDING DEPARTMENT 2. Structural Components in Place*
40
3. Complete Building*
No. 1163 Office of the Building Inspector
Zoning Form No. 963094 Date 12/11/97 Fee$40.00 Check# 2059
Page, 25C Parcel 76 ,Zone URB Section 127 ❑ Yes 0 No
BUI]LDINGPERMIT
*Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Brian Greenwood before Building Inspections
has permission to strip & install 1/2" ply,drip felt & ridge vent,shingle%1spection on Site—Foundations
situated on 294 Bridge St - Joe & Michelle Squires Inspection of Plumbing—Rough
provided that the person accepting this permit 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
Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS ACE N THE MISES
4
Certificate of Occupancy
Building Inspector
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