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17A-080 (3) ;;I' > j .9 II T � II C � O• _. a z rr�^ " II r � > O XI Z ^• rn D Z Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MASS. 1 q Additions ti APPLICa ATION FOR PERMIT TO ALTER Repair / 1 / ,�� Garage 1. Location =3 e C�r `d'�y� / /G r�� L `� �/ �r. Lot No. 2. Owner's name_ n r., o" 5 C f' t Address d ccx le v. 1"f'o^ce,c r 3. Builder'sname Address %yp,,,+ Mass.Construction Supervisor's License No. © 3 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 13. Siding house 14. Estimated cost:- 0 d The undersigned certifies that the above statements are we to the best of his, her knowledge and f. 'G' Signature 6f responsible app.lcant Remarks OAT PLO JUL 2 l99� Crz? roxfllantan . L B ,6 � y �>;saachn'sclla EPARTMENT OP BUILDING INSPECTIONS 212 Main Street Municipal Building Northampton, Mass. 01060 'V WOR CER'S COMTENSATION INSURA-NCE AFF M A,Vrr Crt r (1i�nsc^Jprrmi tt ce) vnth a principal place of business/residence at: (str�...Uci h'/stairJa p) do hereby certify, under the pains and penalties of pcgiuy, (hai: O I' am an employer providing the following v:or�_e�s compensation coverage for my employees working on this job: (Insl=ce Comp2ny) (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) Qnsuranc-- Company/Poky Number) (Expimtioa Date) (Flame of Contractor) (Insurance CoIIrpanyiPol y Number) (Expiration Date) (Name of Contractor) Omsurane~CompaM,/Pobcy Number) (—X-P LM60D Dai0 (Name of Contractor) (Lasu=c-- Company/Poky Number) (Expiration Date) 01'1,h 2,6d oral s}wd ifnooc.-ry to c)�infoemi!ioa pexhimng 10&ll oodre�on) ( am a sole proprietor and have no one working for me. ( ) I am a-home owner performing all the work myself. NOTE_please be awurc chit v4nlo bomwwncn wbo clay persom w do :n• Doc coasrvction'or rcpa.ir work oa a dwclting of W rnoco th.n tbrto units in which the bomoowner rc=de3 a oa tba gouods W rtemat thactn etc oo(gcncrolly 000 kk-d to!x employ—varlet tbo wockcr i cca4>c dices Act(GLl S2,s 1(5)1 applinDon try a bomoowacr for a liccnx cc permit may cvidmoc the legs etahsi of an cacployx underttso WaicoCs Compomaiioa Act' I undmtxad&4:t copy of thi:eatcmcai may be forward.d to tlw Dcparamcnd oflndtiu5i el Ancd, fl&Offioo of lavm-noe for tb4 coverage varificstion and that failtme to ccasrc coverage under suction 23A of MO L 152 m laid to tbe'imposrtioo of criimiasl pcaalrics ' coausta3g of a line of up to si,Soo.Oo and/or imprisommeni ofup to cm year and civil pemitiia is the foam of a Stop Woct Order and a fim 0(5100.00 141Y againA me S fi ned day of 1997 For dgrtwc"tt,o ooy - Permit Number map- Lot# Signae=of LiocnsoclPcrmiticc 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 color= to be filled in by the Building 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 parkingi of Parking Spaces of Loading Docks Fill: (vol-Ume--& location) 13 . Certification: I hereby certify that the information containe herein is true and a curate to the best of my knowled D�"E: ,,2� �7 APPLICANT's SIGNATURE ?" NOTE: Issu oe of a zoning g permit does not relieve an applicant's burden to comply M!lt"'rApll zoning requirements and obtain all required permits from the Board of Health, Conservallon Commission, Department of Publio Works and other applionble permit granting authorities. FILE # AL 2 8X97 File No. ZONING PERMIT APPLICATION (§10 . 2 PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: e. s erg' .' Address: 2. Owner of Property: ,��'H C v--e 5 C fi r Address: 3R Ca do v n 5T (-(o,-eg c e jU Telephone: S'SC 17 -3 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): ,� 4. Job Location: 3S- Ca✓'l/ (oup, S�` l f o eM c e. Parcel Id: Zoning Map# 1217— Parcel# d District(s):�j �CG (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. 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 by obtained Obtained ,date issued: (FORM CONTINUES ON OTHER SIDE) .,. FILE # JUL ?_ 81997 APPLICANT/CONTACT PERSON ADDRESS/PHONE: /�!g Q cc'/, �`� U 17 PROPERTY LOCATION: /fit ' � Cr - MAP PARCEL: C) ZONE GC14 Gt THIS SECTION FORAFFICIAL USE ONLY: PER UT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FOR1Y MIND OUT Fee Pnid Riiildina Permit Filled mit FPr Pain &- ad RPmndic-lin Addifinn to Existing Ruildinu PInTiOnchided- Ownpr/OrcupantStat T OLLOWING 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: Curly Cut from DPW Water Availability Sewer Availability Septic Approval-Bd of Health Well Water Potability-Bd Health Permit from Conservat' Co n p 7 Signature of Building, for Date NOTE:kmuanoo of at zoning permit does not relieve an applioant's burden to oompty with ail zoning requirements and obtain call required permits from the Board of Health, Conservation Commission, Department of Public Works and other applicable permit granting authorities. � ' i p F I i J)� 1 i J { I + �� { I I { � I I i 1 i I i 1 i f �, f City of Northampton REQUIRED INSPECTIONS } � BUI[LiDING D 1. Footings and Walls 2. Structural Components in Place* 3. Complete Building* No. 716 Office of the Building Inspector Zoning Form No. 962598 D)te 7/29/97 Fee$20.00 Check# 1716 Page, 17A Parcel 80 ,Zone uRA/WSP Sc^Lion 127 L) Yes El No BUI, DING PE )�, * Plumbing and Electrical Inspections required THIS CERTIFIES THAT Western Mass Siding/Roof ing before Building Inspections has percussion to strip houseroof & reshingle Inspe(:7on on Site—Foundations situated on 38 Carolyn St - Florence - John Crescitelli Inspection of Plumbing—Rough provided that the person accepting this permit shall in every respect Inspe<;tion 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 Ordin�:nces relating to the Construction, Ins}ection of Wiring—Rough Maintenance and Inspection of Buildi:ags in the City of Northampton. Any violation of any of the temis 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 Ix.issued by this office upon return Insulation Inspection of this card signed by the Plumbing,Wiring and Building Inspectors. By`:ilding Inspection—Finish ���• ��/U' �����-,;, ** Install per Manufacturer's information: windows,vinyl siding,roofs and woodstoves Smoke B�tectors(F ire Department) Other 'a THIS CARD MUST BE DISPLA D IN A CONSPICUOUS PLACE ON PREMISES Certificate of Occupancy Building Inspector