31D-126 (7) i
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No Alterations
a NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location 17fadgmicCAU& MAL Lot No.
2. Ownee s nam Address%Sa m,,
3. Builder's name U2 > Address. ((�(L -�f –( -T, } c»o{�,, -
Mass.Construction Supervisor's License No. 039"x(1 G Expiration Date A14E5 Wnm
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,15LrCr&
13. Siding house
14. Estimated cost:- 1'100•o0
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
Signature of responsible app icanl
Remarks
�0 Oy
OF ,� r
fo�?'! "PR'M¢1hS Aas%xcansctIv
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building yy
Northampton, Mass_ 01060
WORKER'S COMTENSAUON INSURANCE AFFIDAVIT
(li censeeJpermi ttec}
with a principal place of business/residence at-.
(phone#)
(strut/city/stateJz�p)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following work-er's compensation coverage for my
employees working on this job:
(Lnsvrancc 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) (Insurancic Company/Policy Nuinbcr) (Expiration Date)
(Name of Contractor) (Insurance Compau),/Policy Number) (Expiration Date)
(Name of Contractor) (InsZ=ce Comp my/Policy Number) (Fxpii-abon Date)
(Name of Contractor) (Insurance Company/Policy Nuuiber) (Expiration Date)
(atladt additicaa.l zhcri tf noccxz. w nchxSc i foruratioo pcst.=_rL&to all o::�-ndora)
(�I am a sole proprietor and have no one working for me.
( ) X am a home owner performing all the work myself.
NOTE:please be aware the wbalo homcowncn who employ perz w do coas:nlc600 or repair wane on x dwelling of
not moro than thruo units is which the Fwcpoowncr midd a oa tho Vourrb appurtcnani tS=w ate oo(wally eoost6cmd to be
emPIOyrra-der the wot+='%oOmp=s4on Act(GL152,sa 1(5)),appdcation by a homeowner for a Berns=oe permit maY c d the
legal dutuo of an amployoc under dio Workcex Compemation Ad
I un&r%txud that a oopy of this r fzmccd may bo fbrNvnrdod to tbo Dcpertmco2 of Indzr d A=d—&Olfioo of InzurRnco for tho
0o verification and that fadusc to somm eo on of--n.tl -
vcsxgc vcrago uniicr soctioa 2S A of MoL 152 can Icad to tho impas>v pcnalh ,
cocuisUna of a fine of up w 11,500.00 and/or imprisonnx�i of up to one yrar and civil p�ltia in the form of a Stop W orlc Order and a
fine 0(5100.00 a dry against mc.
For&PxrtnCOtil—O01Y
Permit Number
Mai----I°t#
Signature of Lior=scc/Pcr
10. Do any signs exist on the property? YES NO
IF YES,describe size,type and location:
i
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 colic= to be filled in
by the Building D�par at
Required I
Existing Proposed By Zoning
Lot size
I
Frontage
Setbacks -
i
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking! �
# of -Parking Spaces
# rof Loading Docks
Fill:
-(volume-& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE:-
192 APPLICANT'S fif. (arx�)
NOTE: 11asdanaa of a zoning permit does not relieve an applicant's burden to oomply w!j h all
zoning requirements and obtain all required permits from the Board of Health, ConserVtltion
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
1998
File No.
o��r°F"I'I SL *P I x G PERMIT APPLICATION (§10 . 2
".
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 41(91 ,' &,WA r )
Address: Telephone:NhJL2jc�79U7
2. Owner of Prope
Address: be I
M4 Telephone:
3. Status of Applicant: ✓ Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# Parcel# District(s):r R
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. De cription of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
' t
red
�t,�IQPt -�.v dL�'f �' Pa-11 g;r .
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.
S. 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 be obtained Obtained ,date issued:
(FORM CONTINUES ON OTHER SIDE)
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FILE
MAY 5 .
LAPPLICANT/ OP TACT PERSON:
a�ns� `
PROPERTY LOCATION: 7/'
MAP �1� PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PER HT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONTNG FORM M,1 ED OUT
Remodeling Interinr
Addition to Existing J&;J�t� ec
Arreqsn
THE LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
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 ter Availability Sewer Availability
.Septic Approval-Bd of Health Well Water Potability-Bd Health
P t from onse ati on mi i
01 - � 9 f
Signature of Building for Da e
NOTE:Issuance of a zoning permit does not relieve an applicant's burden to comply 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.
City of Northampton REQUIRED INSPECTIONS
A � Walls
BUILDING DEPARTMENT 2. Footings Components in Place*
3. Complete Building*
NO. 1551 Office of the Building Inspector
Zoning Form No. 963492 Date 5/6/98 Fee$20.00 Check# Money Order
Page, 31D parcel 126 ,Zone CB Section 127 ❑ Yes ® No
BUI]LDINGPERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT w M Brown before Building Inspections
has permission to replace slate & ventilation to be flashed Inspection on Site—Foundations
situated on 79 Masonic St - First Church of Christ Scientist 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 CONSPICUOU ISES
Certificate of Occupancy '
Building Inspector