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Zoning
Miscellaneous Additions,Repairs.Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. lq Additions
' ! Repair
' APPLICATION FOR PERMIT TO ALTER
Garage
(.CO � / 1 1
1. Location t CO /-tMG,L V , I � O jr-gym /214: Lot No.
2. Owner's name J / Address Ga,'j`lt'7 A/
3. Builder's name 7T7 69 C—)K Iz Address 2,2' 17 'i?t 2'
Mass.Construction Supervisor's License No. Expiration Date ZZ 1t40.417'
t40 ;r 2
4. Addition p
5. Alteration K_- P laCQ ill IyC `��1 r i 7 _A 'l,
v
6. New Porch
7. Is existing building to be demolished?
8. Repair after the fire K
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
r
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
cLA
ignature of responsible app,ican!
Remarks
oQ'��^MpTO
s V1,14 9199(
Grit� of z
9 Btasaacilnsctis
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building 'o�H 1���•
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(licenser/permittee)
with a principal place of business/residence at:
f� �°L'�?k'I°1a� `�'� _T� ►4 c-, (phone#) 54)9-616
(str=Ucity/staW2ip)
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:
A)Aa
(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 Con pany/PoLicy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach ad&tioml shed ifneoasary to include information perwining to all ooutrad )
(N/6 am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that while homeowners who employ peaom to do maintenancg suction or repair work on a dwelling of
not more than throe units in which the homeowner resides or on the grounds appurtenant thareto are not generally considered to be
employers under the wodm z compensation Act(GL152,ss 1(5)),application fry a homeowner for a license or permit may m ideaoe the
legal statue of an employer under the Workeet C.ompeosdion Ad
-
I underuaad that a copy of this statement may be forwarded to the Deparbnea2 of rIdutrial Accidao&dilioe of Insucanoe for the
coverage verification and that failure to secure coverage under section 25A of MGL 152 can lead to the imposition of criminal penalties
ooasis<ing of a fine of up to$1,500.00 and/or impsisomnend of up to one year and civil penalties in the fort of a Stop Work Order and a
fine of 3100.00 a day against hue.
Signed this 1{ k- day of 199 - Fa dep to ow this only
Permit Number
�Itwe L��erm�ittee Map# I.ot#
Si
10. Do any signs exist on the property? YES 1% NO
IF YES,describe size,type and location: F-602VT 19C LA-)LAU 0,L,/
s
Are there any proposed changes to or additions of signs intended for the property?YES NOUN.
IF YES,describe size,type and location:
I1. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This columm 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
' &paged parking)
# of Parking spaces
of Loading Docks
Fill:
4 vol-time--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowled e.
_1
D,-WE: C' APPLICANT's SIGNATURE
NOTE: 1 u o® of a zoning permit does not relieve an plioanY urden to oom h/ wit all
4,.
zoning requirements and obtain all required permits from the B96rd of Health, Coinaervation
Commission, Department of Publio Works and other applioabla permit granting authorities.
FILE #
MAY 91997
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASpE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: I '. J ON CJ 'r
Address: 12 GI fr - A + L Telephone: 65L6
2. Owner of Property:: /�yi ,c , 1_
Address: `� c C_QF/ J ` ' rah' FJl Telephone: S 6 `� �
3. Status of Applicant: Owner Contract Purchaser Lessee
�Other(explain):
4. Job Location:
Parcel Id: Zoning Map# b 1Y Parcel# District(s): � / ---
(TO BE FILLED IN BY TSHE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property Ist �' ''t ' � S
6. Description of Proposed Use/Work/Project/Occu ation: (Use additional sheets if necessary):
IQ " iI
OF
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 V- 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)
t FILE t 91 2 2
MAY 1997
APPLICANT/CONTACT PERSON:
ADDRESS/PHONE: v -
PROPERTY,, L,O��CATION: - ��'}"l jq4d4_
PARCEL:/ 3 Z NE-�
THIS SECTION FOR:OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
TOMNG FORM M.I.RD OUT
Fee PAid
Ridlding Permit Filli-d ""t
;�_
-Remndelin2 Interior
Addition to Existing -7 q 1:�
T 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 Conservation Commission
Signature of Building l4ector Date
NOTE:Issuanoa of a zoning permit does not relieve an applicant's burden to oomply 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.
L
Cit y Northampton TIof REQUIRED INSPECTIONS
} ,
BUILDING DEPARTMENT 1. Footings and Walls 2. Structural Components in Place*
3. Complete Building*
No. 374 Office of the Building Inspector
Zoning Form No. 962220 Date 5/9/97 Fee $60.00 Check# 522
Page, 32A parcel 183 Zone URC Section 127 ❑ Yes El No
BUI]LDINGPERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT peter Radke before Building Inspections
has permission to reshingle 3 buildings Inspection on Site—Foundations
situated on 73 Bridge St - Coolidge Apts - Back 23-28 Front 1-16 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 THE PREMISES
Certificate of Occupancy
BGi ding Inspector