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17A-141 (3) T � 7 Z _ � 1 r 1 Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MASS. 1 g Additions a APPLICATION FOR PERMIT TO ALTER Repair Garage 1. Location Lot No. 2. Owner's name P),LL \161rti` � Address 3. Builder's name � l°�'S l �..!r+ rC Address Mass.Construction Supervisor's License No. / �� 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 cosL- 2, %L3ci The undersig certifies that the above statements are true to the best of his, her know and belief. Signature of responsible app lcant Remarks • 4'CttAl'1P7. goo ��g �i �9'�► Crx� cif ��#I#ttnt�tntt - �- �1a548rll tiSett4 m -�bEPARTMENT OF BUILDDIG INSPECTIONS ~ 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFI]DAVTT --•- (licenset'Jpermitiee) ,-r with a principal place of business/residence at: (phone#) �� (street/city/statrhip) 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 Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additioml shod if necessary to include information pertai¢iug to all coatm o rs) ( I am a sole proprietor and have no one woriang for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that while homeowners who employ pcnoac to do m inten ucc,comavaion or repair work on a dwelling of not more than three units in which the homeowner r=&3 or oa the grounds appurtenant thereto arc not gco rally oomide ed to be employers under the worlcets mutton Act(GL 152,ss 1(5)),application by a homeowner for a license or permit may evidence the legal status of an employer under the Works Compemation Act I understand that a copy of this statement may be for waxx d to the Depvmmco2 of Inds sl d Aectdw&Moe of Insurance for the coverage verification and that failure to aocure ooverago under soction 25A of MGL 152 can lead to the imposition of criminal penalties ooasisting of a fine of up to S1,500.00 and/or imprisonmeut of up to one year and civil penalties in tie form of a Stop Work Order and a fins of 5100.00 a day against M Signed t 3_day of �""/Vc, , 1997 For dgmtabcaw use only t - ' Permit Number i Map{{ Lot# Stgnahtre of Li ermitteme 10, Do any signs exist on the property? YES NO Y IF YES, describe size,type and location: Are there any proposed changes to or additions of signs intended for the property?YES NO_4_ IF YES,describe size,type and location: 11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. Thi= —.Im= 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 f rof Loading Docks Fill: 4 vol-ume--& location) 13 . Certification: I hereby certify that the info r tion contained herein is true and accurate to the best of my know ge. DATE: G �� APPLICANT's SIGNATURE --= NOTE: leauanoe of a zoning permit does not relieve an applioanVa burden to oom wit { zonin Ph/ h1,tlo g requirements and obtain all required permits from the Board of Health, Conservtation Commission, Department of Publio Works and other applioable permit granting authorities. FILE # a ^� ��y � =~,. � \ File No. _- - - �� .� u�� « �r�� ~ �� PLEASE =E OR PRINT ALL INFORMATION 1. Name of Applicant: Address: 2-» Telephone: 2. Owner of Property: Address: �e|e�nona' 3. Status of Applicant: --t—Owner ontrac±Purchaser Lessee Other(explain): �� 4. Job Location: ^�r�ry c- c;^ Parcel Id: Zoning yNap District(s): (TO BE FILLED |NBY THE BUILDING DEPARTMENT) 5. Existing Use of8truotuno/Pnopedy G. Description of Proposed Uan/VVork/P 'act/Occupation: (Use additional sheets if necessary): 7. Attached Plans: Sketch P|en Site P|an Engineered/Surveyed Plan o Answers to the following o questions may ueobtained by checking with the Building Dept m,Planning Department Files. O. Has o Special Pmrnnh/Vahanom/Finding ever been issued for/on the site? NO DON'T KNOW YES [F YES,date issued: IF YES: Was the permit recorded ot the Registry ofDeeds? NO DON'T KNOW YE IF YES: enter Book Pagm_ and/or Document 9. Does the site contain a brook, body of water orwetlands? NO DON'T KNOW `/E IF YES,has a permit been or need to be obtained from the Conservation Commission? Needs toba obtained Obtaineddate issued: _ (FORM CONTINUES ON OTHER SIDE) - ' FILE # JJNr � APPLICANTICQNTACT PERSON: 14y1w,60 ,E . ppI� ESS/PHOINE: PROPERTY L CATION: f MAP PARCEL: ZONE, THIS SECTION FOR.OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONINCi FORM ITITIED OUT 11iii1ding Permit Filled mit 17 �o ✓ Type of Constniction- 7 J THE,.5,OELOWING ACTION HAS BEEN TAKEN ON THIS AP ICATIOM <' Approved as presentedfbased 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 Per om Conservation 4 mission Signature of Building or Date NOTE:Issuanoe of a zoning permit does not relieve an applioant's burden to oomply with all zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Department of Publio Works and other applioable permit granting authorities. City of Northampton REQUIRED INSPECTIONS A e } ' DEPARTMENT 1. Footings and Walls BUILDING �► 2. Structural Components in Place* 3. Complete Building* NO. 495 Office of the Building Inspector Zoning Fonn No. 962345 Date 6/6/97 Fee $20.00 Check# 1117 Page, 17A parcel 141 ,Zone URA Section 127 ❑ Yes EJ No BUH-JDING PERTVHT * Plumbing and Electrical Inspections required THIS CERTIFIES THAT Charles Laveck before Building Inspections has permission to strip & reshingle roof Inspection on Site—Foundations situated on 211 Chestnut St 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 woodstoves Other THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON T PREMISES Certificate of Occupancy -; ,�. wilding Inspector