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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. �� ��� Alterations
NORTHAMPTON, MASS. LL 1922. Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location T (� / '� Lot No.
2. Owner's name �17/�'a.i .3/�= ��:, y Address ' `�'% TZ-cjY'.-,��r e -
3. Builder'sname C K . f -tl'�SIG� Address? �D G'�-2 y' 02:",14-ev-
Mass.Construction Supervisor's License No. tD f_ ?�'rLcA- Expiration Date L'2 I
4. Addition
.�ST/jc.v
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-
i
C' The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signa ure o responsible app,icanl
Remarks
04ittAlNp�0
9 6 AUG 2 "(} 199 f �lassRCflrtsctfa r
DEI?ARTMENT OF BUILDING INSPECTIONS
212.Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATTON INSURANCE AFFIDAVIT
(license&permittee)
with a principal place of business/residence at:
S3 c r2z 'fi '- �h _Mk "'(phone )
(Sti=U6ty/SUdd2ip)
do hereby certify, under the pains and penalties of penury, that.
Y 4 I am an employer providing the following worker's compensation coverage for my
employees working on this job:
AZ-VA 1-3 /,f
ce Company) (Policy Number) (Expiry 'on 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 compemtion policies:
(Name of Contractor) (Insurance Compatty/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 shed ifnecessary to include information pertaining to all 000tmctors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:pl ease be aware that while homeowners who employ per%=to do makdea ace,oonstructioa or repair work on a dvmZ g of
not more than three units in which the homeowner resides or on the grounds appurtcaaut thereto are not generally ooasidered to be
employers under the tveakces oompc oration Act(GL152,ss 1(5)),application by a homeowner fora liccase or permit may evidence tho
legal slaters of an employer under the Worker's Compensation Act
I understand that a copy of this"xmeat may be forwarded to the Dgmrwxcd of Industrial A=dea&Offioc of Insurance for the
coverage verification and that failure to aeatre coverage under section 25A of MGL 152 can lead to tho imposition of criminal penalties
oomisting of a&ne of up to$1,500.00 and/or impriu si of up to ono year and civil pemrities in the form of a Stop Work Order and a
firm of$100.00 a day against me-
Signed this I _day of 1997 For deputmmtbl use only
Permit Number
t�— Mao Lot#
Si of Licensee/Per ni
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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 colnmm 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
3G
Bldg Square footage
%Open Space:
(Lot area minus bldg
' &paved parking)
of "Parking Spaces
t1`
of Loading Docks
L
Fill:
(vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my kn wledge.
_1.
DATE: � 20/1 7 APPLICANT's SIGNATURE
t" NOTE: mauanoe f a zoning permit does not relieve an a 1 ants bu d n to oom wit
PP Pt]/ tr,..elt
zoning requirements and obtain all required permits from.th Board o Health, Conservation
60mmisaion, Department of Publio Works and other applic le permit granting authorities.,.
=:' FILE #
AUG 2 01997
File NO.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: Telephone: S ,Y' / L/»o"-�z,
2. Owner of Property: ��
Address: -SL- L_! -T Fz-ek-r,"zc Telephone: °)S`f JT 3 /a'
3. Status of Applicant: Owner Contract Purchaser Lessee
_Other(explain):
4. Job Location: — L-t/Lk€
Parcel Id: Zoning Map# Parcel# District(sa e L
(TOD IN BY THE BUILDI G DEPARTMENT)
5. Existing Use of Structure/Property r �/ �js6't-.
6. Description of Proposed Use/Work,Project/Occupabon: (Use additional sheets if necessary):
r-yz1hA C- Q'n.T3 I D C 13/i c C-4- G.,)1'e C� S`r 4&-'z
w"Dm
n��ST7�c+-, .''�'t�� i3z ✓ar'i�S c�'� ��.'�2�.5. _ NHS �-j,�
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 X 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 X 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)
r FILE I
AUG 2AP 99 CANT/�ONTAC PERSON: -
ADDRESPF10NE•
PROPERTY LOFATION:
MAP 1711 PARCEL: ZONE j��
THIS SECTION FOR:OFFICIAL USE ONLY:
PERMUT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM ETILED OITT
Fee Paid
Rnilding Permit Filled mit
Fee PAid
Type of Constnirtion-
Additinn to Existing
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 Conti o n
�/,
Signature of Building his2otor Dat
NOTE:issuanoa of at zoning permit does not relieve an applicant'a burden to comply with ail
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commisalon, Department of Publio Works and other applioable permit granting authorltles.
( ,its of Northati-ipton REQUIRED INSPECTIONS
BUILDING DEPARTMEN .r 2: Footings Walls Components in Place*
3. Complete Building*
No. 794 Office of the Building Inspector
Zoning Form No.
962682 Dare 8/20/97 Fee$40.00 Check# 2409
Page, 17A Parcel 244 ,Zone URB Section 127 ❑ Yes ® No
BUI DING PERMIT
*Plumbing and Electrical Inspections required
THIS CERTIFIES THAT John z-eminski before Building Inspections
has permission to finish basement & install door Inspection on Site—Foundations
situated on 82 Lake St - Joanne Katz 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, Insp:.ction of Wiring—Rough e' ' 47
Maintenance and Inspection of Buildncgs in the City of Northampton.
Any violation of any of the terms above;toted is an immediate revocation Inslection of Wiring—Finish
of this permit.Expires six months from date of issuance,if not started. `'rui.lding 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 6 -41
Smoke Detectors(Fire Department)
Other
THIS CARD MUST BEDISPLAYW IN A CONSPICUOUS PLACE ON MISES
Certificate of Occupancy
Building Inspector