17C-250 (3) . •rye
► ' ` 0023
Date Filed �(�L , v
`� r✓— �t� File No.
T
ZONING PERMIT APPLICATION
I. Name of Applicant: A • L�t)N
Address:--71 MteHGLH1')N A\JE: *` N -tr)hJ Telephone:
2 . Owner of Property: -TO gtZ fi5E1 ZSr S M Ak 4
U2 L� 4- (-4,, r? -7,>
Address: - Telephone:
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain:n wee ti5�2.
4 . Parcel Identification: Zoning Map Sheet# 0 C- Parcel# Z5
Zoning District(s) (include ov rla s
Street Address 51 g &Z
Required
5•
Existing Pro nosed by Zo,,n in
Use of Structure/Property g,= 9A K PAS 7-
(if project is only interior wor1k, SUP to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
- side L: R: L: R:
- rear
Lot size
Frontage.
Floor Area Ratio
. %Open Space (Lot area minus
building and parking)
Parking spaces
Loadinq
Signs
Fill (volume & location)
6. � Narrative _Description of Proposed Work/Proe
' ct: (Use additional sheets
if necessary)
w_ n��L Lti4� v urlt_��Lc �g PcK-�
. ES'7aBc.tSNri'En.J'�.
'r
7 . Attached Plans: Sketch Plan Site Plan
8 . Certification: I hereby certify that the i1-1forma ion contained herein
is true and accurate to the best of my knowledge
Date: 7/,A L/ _ Applicant's Signature X.
THIS SECTION FOR OFFICIAL USE ONLY:
Approved as presented/based on information presented
Denied as presented--Reason:
S ecial" Permit and/or Site Plan Required: Z�
ind'ng fired: Variance Required:
7 A8'
gnat o D to
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply witli all zoning requirements and obtain all required permits
from tho Hoard of Health,Conservation commission, Department of Public Works and other applicable permit granting authoritios.
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location Lot No.
2. Owner's name Address
3. Builder's name Address
Mass.Construction Supervisor's License No. i'�'`/`/_ � Expiration Date / 10--,l oa L-�
4. Addition
5. Alteration "Zi c
6. New Porch
7. Is existing building to be demolished? G�
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 cost:-
The undersigned certifies that the above statements are we to the best of his, her
knowledge d belief.
Y?'� �2�.
Signature of responsible app icant
Remarks
O O
B �aSSRCEpItSt�15
DEPARTMENT OF BUILDDZG INSP=ioNs
212 Main Street ' Municipal Building 'y
�`ORTH6�t�;r tfd Northampton, Mass.' 01060
WORKER'S COMPENSAXTON INSURANCE AFI'TDAVIT
(licensee/permitlee)
with a principal place of business/residence at:
/ ? t, c (phone#)
� �' (stcr~t/city/stalPJap)
do hereby certify, under the pains and penalties of penury, 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)
S
( ) 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) (LasZilanc Corn auy/Poky Numtcr) (Expiration Date)
(Name of Contractor) Jasuramcr- Comoa iv/Poticy Ntun Date)
(Name of Contractor) (Insurance. Company/Pohcy Numbu) (Expiration Date)
(Name of Contactor) (Insurance Company/Policy Number) (Expiration Date)
(atta)ch additioml sl:crt ifneccnxry to xu c iaformlEoa p:f�to all ccofrac"on)
( I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:plczsc be aware that wt„ilo a3play perTOax to do mxiatc'-uncc,omstr ioaor repair worst on a dwelling of
not meta than tbrro ututs in which the bomco-Ama reside or oa tbz g o is apputtenaut ibcrdn arc oat grncrallY wcsidacd to be
cmployas under tbo write` .compc=afion Art(GL152,=1(5)),application by a homcocavcr fora Haase oc pamd tray evidence the
legal etahra of an employor under the Workces Compcmaiion Act.
I undcr�d thst a copy of thu ctatcmmt may bo forvvtdod to tba Dtpartnx of Inds nl Ac6dcQ&Offioe of Iaauznoo forth'
0ov-tr1&C verification ttnd that faU=to seatrc cot -o under soctioa 25A of MOL 152 can lad to tbd imposition of aiminil pcaalbcs
ooa tistiag of a fim of up to S 1,500.00 znNor tmpttiw+ancat of tip to one year and civil pmalGa is the form of a Stop Work t�tdcr and a
fimc of S 100.00 a ally ttitui rtx
For dcputmcual use aoly
Permit Number
z �.. � 1. t 2viap Lot 4 ,
Sigmawrc ofulocn5cepermitice Mve
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 NO2L
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This cola to be Pilled in
by the R= ding 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 of Loading Docks
Fill:
(vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is tru �nd accurate to the best of my knowledge.
DATE: � S! APPLICANT'S SIGNATURE �4 %
L�
NOTE: lsgua oe of is zoning permit does not relieve an appiioant's burden to oomply withl 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.
FILE #
x
Fi 1 e No
T ;i
:Z- 0NING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: L�
Address Tele hone:
l�
2. Owner of Property:
Address: 7 -telephone:
3. Status of Applicant: IJ _Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: / 2e-
Parcel Id: Zoning Map# /7 Parcel# � District(s):- /
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
Ix G�G�
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 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 L_ 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)
Irk.
Reference No: BP-1999-0266
Department: ................•••••••..........•.
Building,Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
replacement windows REC-1999-000654
.........................................................................................
Paid By: Paid in Full On:
- ......
And.rew.Church......................................................... Thu Sep 03 1998
....... ...... .............
.. . ...... ......
Received By: .Check. . .No:...................
Linda Lapointe 1328
.........................................................................................
.••......•••.•••.••.•••...••.•.••.....
DEPARTMENT'S COPY Amount.- $20.00
...........................
DEPARTMENT FILE COPY 51 NORTH MAIN ST
CITY OF NORTHAMPTON
BUILDING PERMIT
Owner's pulling their own permits or dealing with unregistered contractors for applicable work do
not have access to Guaranty Fund(MGL 142A)
Issued: Permit No: Inspector: Tracking No.: Fee:
03 Sep, 1998 BP-1999-0266 $20.00
GIS #: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
1851 17C 250 001 51 NORTH MAIN ST URB 21780
Contractor: License Type: Insurance:
Andrew Church HIC
Address: License No.: Insurance No.:
174 Spring St 104480
City: State: Zip Code: Phone:
FLORENCE MA 01062 (413) 586-0918
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0572 windows replaced $2,000.00
Description of Work:
INSTALL REPLACEMENT WINDOWS
GeoTIVIS@ 1997 Des Lauders&Associates,Inc. Signature: