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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
/ Garage
1. Location 3 y c4it {'i�ir �jJ {��9NP Lot No.
2. Owner's name ,/�� l9 j I/ we,S l Z Address ��� s e�'jc
3. Builder's name (�• /1n do Address
Mass.Construction Supervisor's License No. /D'J y�� Expiration Date
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 ¢ Oyt / o -
13. Siding house
14. Estimated cost:-
i
The undersigned certifies that the above statements are true to the best of his, her
knowledge and be cf.
1gnature of responsible app,icant
Remarks
MENNOW
A
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m DEPARTMENT OF BUILDDyG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WOR KER'S COMPENSATION INSURANCE Ar,MAVIT
(1i�Jpermitt�}
with a principal place of businesslresidence at:
_(phonetf)
(StSC~,i/C1tY/St21CJ )
do hereby certify, under the pains and penalties of erjury, that.
( ) I am an employer providing the follo`ving""ror�er's compe;.sauon coverage for my
employees working on this job:
(Lnsu c-- Company) (Policy Number) (Expiration Date)
( ) I am sole proprietor general contractor or homeowner (circle one) and have hired
the contractors steel below who have the followmi g worker's compensation policies:
(Name of Contractor) (Lasurancc Conmazry/Poucy Number) (Expiration Date)
(Name of Contractor) (I-11surancz Company/Policy Number) (Expiration Date)
(Name of Contractor) (laamaIlc,,�Compauy/Policy Number) (Expiration Dale)
(Name of Contractor) (Lnauano--Company/Policy Number) (Expiration Date)
(atfadt additioml shod ifnoo=ix y to iacluck informtioa pctaining to all coa�n)
V, am a sole proprietor and have no one working for me.
( ) I am ahome owner performing all the work myself.
NOTE:Please be aware that whDo hocrxxm eta wtio employ Pa-;O=to do�iTlfCUInCc wasuuctioo ar rcpa r work on a&xlling of
ant mom than tbroo units in which the bomoowncr mid=or m the ground,appurtcnsni thcdo aim Dot gcncally coandcr d to be
employ=under tbo work='% scion Ad(GL152,=1(5)�application by a botneow ocr for a borne a perm may cvidcn=the
legs(etzhia of an employoc undertho Woricces compoosaLion Act
I undcrsvtnd thii x copy of thu ctat—rd may be focwwded to tbo Dcpnctmaot of Indzutri d Anodca&Of —of Izraui000 for d-
eovaage vrrifieatioc and that fadure to aeauc oova-?LV undo scdion 25A of MGL 152 can lead to tba impos—of aimirul Pcnalti=
ooamstasg of a fine of uP to S 1,500.00 apd(oc imprisonment of up to one y=and civil pcnaltics in the form of a Stop Work Orda and a
firm of S 100.00 a day&&Last mc.
%Silgpned this day of 1997 For dcpartar�al—�y
Permit Number
Nfap# Lot#
ahtre of L- crmitice
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 V
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This C07== to be f1210d in
br the Bta2ding, Department
I Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lotarea minus bldg
&paired parking j
# pf Parking spaces
f of Loading Docks
Fill:
-(vol-ume--& location)
13 . Certification: -Thereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DAVE: APPLICANT's SIGNATURE
NOTE: Iss a oa of a zoning permit does not relieve an al;PlJoaAVs burden to oomply wit47011
zoning requiramonts and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applicable permit granting authorities.
FILE #
F�N 9199 �
DEPT Of$UILD�t�G INSPE GT1t``N'
NOR h, . File No
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: r t-ii�p aQ
Address: / '� / /�?�k e �4 'jt2 Telephone: 2 jY-2
2. owner of Property: Az� 1,44
Address: qv —Telephoner 7— 9V 9�
3. Status of Applicant: Owner Contract Purchaser V/ Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# Parcel# / U District(s):�,
(TO BE FILLED IN BY THE`B�U_ILDING DEPARTMENT)
5. Existing Use of Structure/Property ill
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/Vadance/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)
I E FILE # 10 1-) i
Lo
DUJUN 91997
APW T/CONTACT PERS �77
PNTOR uao a AP ONE:HA'� E
PROPERTY LOCATION: 7
NLAP /Ze PARCEL: ® ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM EII LED MIT
THE LOWING 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 Co mission
Signa o .� ate
NOTE:Issuanoa of le2ning permit does not relieve"an applionnt'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.
City of Northampton REQUIRED INSPECTIONS
1. Footings and Walls
BUILDING DEPARTMENT
v � 2. Structural Components in Place*
3. Complete Building*
Office of the Building Inspector
No. ri16
Zoning Form No. 962361 Date 6/16/97 Fee$20.00 Check# 1609
Page, 17C Parcel 120 ,Zone URB Section 127 ❑ Yes ® No
BUI]LDINGPERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT George Thibodo before Building Inspections
has permission to shingle roof over 1 existing layer Inspection on Site—Foundations
situated on 34 Sheffield Lane - Paul Westort 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
** Install per Manufacturer's information: windows,vinyl siding,roofs Smoke Detectors(Fire Department)
and woWstoves
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS ACE ON MISES
Certificate of Occupancy
Building Inspector