17C-116 (4) > o
< y
v v o• �
D m
a
3 Z m
p
,n Z
cv > 1
Z p
m
Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 6US% "2� 19 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location S�l 'FF�l=�D L �1 F`ONf�' � Lot No.
2. Owner's name Address 5 ff 1-4,
3. Builder's name—Tife—'k- Address
Mass.Construction Supervisor's License No. DS�Z`j�� Expiration Date /S 9
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 �17C'`06 jQ(f 57),14G S02C `E- 0,16t F,
13. Siding house
14. Estimated cost-
The undersigned certifies that the above statements are we to the best of his, her
knowledge and be ief.
Signature of responsible appocant
Remarks
fi° °s xD �II&17T�JrfBTT
mA� t
T it
B Q y.�i5l RCllRtrli/
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Strect ' Municipal Building
Northampton, Mass. 01060
W0RICER'S COMPENSA"floN INSURANCE A � t AVTT
(li�nse:Jperuli tt c:)
with a principal place of busness/resideoce at:
C�cl�l 1?-d 33�
(strr"11ci t}'/stzirJ�p)
do Hereby certify , under u3e pens and penalties of perjury, ihaA.
O I am an employer providing Ule following V,'or�er's colnpensnrion cove age for My
employees worming on this)ob.
(lnsi=c-- Company) (PoLicy Number) (Fxpij-2boa Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the followiDg worker's compensation policies:
(Name of Contractor) jnsuranc:� CompanyfPolicf Number) (Expiration Datc)
(Name of Coomctor) (LLnrranc-- Company/Policy Number) (F-xpim6on Dare)
(Name of Con Tactor) (Ins rangy ComtiaQyfPolicy h,amhzs) ( piranon Datc)
0\1ame of Contractor) (LnsLuancc Compiny/Poky TImnbcs) (Expir2600 Date)
(r1U.c?�idditi oQ J c� tl accc�,ry to'cc.`i�iaCccmij ea pc^�uang to�1)wa:r�.on)
I am a sole proprietor and have no one worming for me.
I am a home owner perform"w- all the work myself.
NOTT_please be aw-zm d)4 wlnno b.,,, crz wb,,c,,ply pa':om coot: tioo ar repair work on>duelling of
not mock th.:n thma units in wt ich the bomoowocr resides a oa the you xppi amiaj thereto me oot gcocrelly coan&rcd to be
cmploy�under tbo tvorkcr`:.oco pc=rtica Aa(GL152Fs 1(5)�applic moo by a boinoowncr for a Sccax cc perm i may cvidcm d-
4-94 ctahu of an co Ioyer uodcr tho W,+p e,Compoc vlioa Amt"
I uodcrxt,nd db i a copy of tbia ahlcmcni maybe f«-werd<d to Lb. Office of Iuvc.00 for[tm
coves age vcrific�iioo and that failure to toauc covaabro under scctioa 2JA of MOL 152 can tc�d to tbd imposboa of c rialla4 PcCaloc,
000sisrusg of K froe bCup to S 1,500,0;0 and/or unpraoamcal orup to one year and anT pao 2dGas is the form oC a Stop W ork Ordcr and a
fioo oC5100.00 a day against.m�
S igncd this 25 day of Vt , 1997 For d�t ,�t>o nary
Permit Number
Ma�I
Lot>y
Signature of iccnscc/Fcrmiticc
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 co.1— to be filled in
by the Banding Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L• R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
' &paved parking)
# :o f Parking spaces
f of Loading Docks
Fill:
_(vol-time--& location)
13 . Certification: I hereby certify that the information contained herein
G, is true and accurate to the best of my knowledge.
D7UB: 491Z S APPLICANT's SIGNATU _ r�4C4
2" NOTE: laa ano of a zoning permit does not relieve an applioant's burden to oompty wit4,.4111-
z9ning requirements and obtain all required permits from the Board of Health, Conservation
Commission. Department of Publio Works and other appiioabla permit granting authorities.-
FILE #
a v' 2 51997
File NO.�j 1��t
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: ---T,4t'(,—, ,``�''
Address: 1-36 t!0yn/Th RO" AM�i46l Telephone: 1667—3 3 ST
2. Owner of Property:
Address: /y .S�FFF�1�Gd t/¢s� Telephone: 564— 740 -3
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): j_ U' OC Cr>Afr`_2 T-O K
4. Job Location: /g 5' F<g�Q 1-.4,
Parcel Id: Zoning Map#_'Z� Parcel# District(s):_
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property W 51Dl-,-iV CE:
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_1X_ 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)
4
r
FILE # 9 G t 0 O
A�. ! J I
APPLICANT/CONTACT PERSON: 19—
ADDRESS/PHONE: 0
V
PROPERTY LOCATION:
MAP "7 PARCEL: ��� ONEa�j-
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Z.Q XG FORM MLED OUT
—Fee Pnid
$,iii]dinv Permit Filled split
Fee Pnid ,Z7L_!2
Arreccnry Strnrtime
Building Plans, Included-
-3
THE�� LLOWING 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 n o ion
12-
Signahire of Building ector D e
NOTE:Issuanoe of a zoning permit does not relieve an applioant'a burden to oomply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commisslon, Department of Publio Works and other applioable permit granting authoritles.
� City of Northampton REQUIRED INSPECTIONS
BUILDING DEPARTMENT 1. Footings and Walls *2. Structural Components in Place
3. Complete Building*
No. 806 Office of the Building Inspector
Zoning Form No. 962700 Date 8/27/97 Fee $20.00 Check# 1469
Page, 17C parcel 116 ,Zone URB Section 127 ❑ Yes ® No
BUI]LDINGPERMIT
* Plubing and Electrical Inspections required
THIS CERTIFIES THAT Jack Walton m before Building Inspections
has permission to strip & reshingle backside of roof Inspection on Site—Foundations
situated on 19 Sheffield Lane - John Kendrew 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 pen-nit.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
and woodstoves Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON T PRE ISES
Certificate of Occupancy e
Building Inspector