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17A-181 (2) > o < sy m o r � � m m cv w 3 r .vt � Z > > _a Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MASS. 1 q Additions a APPLICATION FOR PERMIT TO ALTER Repair Garage 1. Location / `/3 �• f�� k7lez,4- Lot No. 2. Owner's name Address/S3 ti,')01lApl 3. Builder's nameLl md�ez� /��.�% Co Address/S 2 IQ�� !� :�/ !2 I- A a L, Mass.Construction Supervisor's License No. Z C /a !! G Expiration Date G — 2 s 9 S 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 S^ /,I 13. Siding house 14. Estimated co t:- The undersigned certifies that the above statcments are we to the best of his, her knowledge and belief. ignaturt of responsib/t app".., Remarks o v 2 4KttAxrpr � �k OCT 2 o 199Y DEPARTMENT OP BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORTCER'S COMPENSATION INSURANCE AFFIDAVIT 7`t a ko p e em jCl .,.. Q r1 41 N'1 ^r C.M . (liccnsccJpermittcc� with a principal place of business/residence at: f, : d R 0 10 D-A.e-p (phone#)_S°t q7713 (strcet/ci /Aatd2ip) do hereby certify, under the pains and penalties of pedury, that: (.�'I am an employer providing the following worker's compensation coverage for my employees worlring on this job: 7i1,4-v,A>r-e c- 3 t 7 (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/Poticy Numbcr) (Expiration Date) (Name of Contractor) (Insurance Comaany/PoLicy Number) (Expiration Date) i (Name of Contractor (Insurance Comp;ul),/Policy Ntlmlxr) (Expiration Date) i (Name of Contractor) (Insurance Company/PoLicy Number) (Expiration Date) nal (attach additio shed if ncccn ry to inclucic infonn ujoo Pcrtainirrs to all cc'&acton) I ( ) I an a sole proprietor and have no one workng for me. ( ) I am a home owner performing all the work'myself. NOTE:please be aware that whi]o homcrowncts who employ Pc.onr to do R.j. r,. cons>rttetion or repair work on a dwelling of not mete thsn throo units in which the bomoowncr rmdca or on tba Clr n appurten.r,t tbetdv uc not Ccmnlly ooaridcrrd to bt employers under the wprktel cation Act(GL152�-t(5A application by a homeowner for a Gaase or permit may evidence tha legal ctattra of an au:ployec under thn Workcel COmpecx ation AL I undersund thst a oopy of this c**tcau- -+rruy be fotwnr to the Dqp to xxt of Ir�duairial Aoeideab Offioo of In or tho coverage vrri icatioo and that failure to sccurr coves agro tuzdcr scUioa 25A of MOL 15Z cm Icad to rho imposition of criaihW peaaWcs oomiumg d a fiao'of up to S"300-00 500.00 and/or kaPisoun'-d of up to one)iar and dv�pctnttics in the form of a Stop Worts Order and a fum 0(510.00 a day agaia:a Me-- Signed this o _____day of p c- 7 1997 FordgMtmoda —only n Permit Number Signauwc of Liccasr�/Pctmittce Map# Lot# �. , 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 column to be filled in by the $uildiag Department Required Existing Proposed By Zoning I Lot size Frontage Setbacks - frnnt - side L: R: L: R: - rear - Building height Bldg Square footage %Open Space: _ (Lot area minus bldg &p=.c,ed pa:king; # of -Parking Spaces # Hof Loading Docks Fill: -(volume -& location) 13 . Certification: I hereby certify that the information contained herein G is true and accurate to the best of my knowledge. DATE: c-7oTT g o 7 APPLICANT's SIGNATURE NOTE: lesuanoe of a zoning permit does not relieve an applionnt's bVrdan to comply witta~ It Czoning requirements and obtain all required permits from the Board of Health. Conservation ommission, Department of Publio works and other applicable permit granting authorities. FILE # OCT 2 01997 File ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: A v%,% Ike 24 T 20 o!� .,— P Co Address:/ 9 7 Zoe k 1j ; it k j !^t&D i_TTelephone: $q `e `L q Z ,3 2. Owner of Property: o�j{R"t ��n A a k S Address: l 3 N• 1►'t�Tf F I ,Z�...c Telephone: S'S e. j a 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): 4. Job Location: 19 /L,'1�C71 ►r�(� (= (e.(I yy- - c —e Parcel Id: Zoning Map# / / Parcel# / 9/ District(s)Yt/jt- (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5, Existing Use of Structure/Property 6. Description of Proposed UseNVork/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 KNO%' / 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 # 962919 1 OCT 2 01997 APPLICANT/CON 'ACT PERSON: AfDDItESS/PHUNE e G' PROPERTY LOCATION: C�2 - MAP J l7 � PARCEL: l f ZONE THIS SECTION FOR-OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONINCI FORM FELTED OUT Fee Pnid Rnilfjin2 Permit Filled njit P aid t/ 0 U — ✓ Accessory 'Striichire c' / 3 i�� ✓ THE ALLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION: ?/'Approved as presentedibased 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 !P ' fro ons at' o G 12- - y' Signature of Building ingKctor D to NOTE:issuanoe of a zoning permit does not relieve an applioant'a 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 applioable permit granting authoritles. ? pity of Northamton REQUIRED INSPECTIONS p ► ! 1. Footings and Walls `' BUILDING DEPARTMENT 2. Structural Components in Place* 3. Complete Building* No. 1011 Office of the Building Inspector Zoning Form No. 962919 Date 10/22/97 Fee$20.00 Check# 1150 Page, 17A Parcel 181 ,Zone uRB Section 127 ❑ Yes ® No BUI[I-JDING PERMIT * Plumbing and Electrical Inspections required THIS CERTIFIES THAT Amherst Roofing Co before Building Inspections has permission to reroof over 1 layer Inspection on Site—Foundations situated on 193 North Maple St - Robert Phelps 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 and woodstoves Smoke Detectors(Fire Department) Other THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS P CE ON ISES Certificate of Occupancy Building Inspector