17C-269 (2) 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 colxmm to be fillad in
by the Duilding 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
&p_aved parking)
ng)
# of -Parking spaces
# 'of Loading Docks
Fill:
Avolume--& location)
13 . Certification: I hereby certify that the information contained herein
is true a d accurate to the best of my knowledge.
DATE: - �y APPLICANT's SIGNATURE , "
NOTE: is uanoa of a zoning permit does not relieve an a lioants burde to oomply with ill
zoning requirements and obtain all required permits f the Board of Health. Conservation
Commission. Department of Publio works and other a lioable permit granting authorities.
FILE #
,11N 5 11998 Fi 1 e No. J�� '3 �
; I sui►: ZONING PERMIT APPLICATION (§10 . 2)
�y
n PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 17,-C '1 /
Address: - "e dkh� elephone:
2. Owner of Property:
Address: �� t2 Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: � '� 'L / .
Parcel Id: Zoning Map# 190 Parcel# District(5y1�
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5 Existing Use of Structure/Property 1
6. Description of Proposed Use/Work/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.
S. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO. DON'T KNOW r 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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Fri
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i
Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. J 19 %� Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
I. Location r� �� Lot No.
2. Owner's name i" l`t ✓1 2S,lag t Address
3. Builder's name-)'0 A/ec t 13 4 ��ti��w.w�� Address � (-
Mass.Construction Supervisor's License No. r4 ( %- Expiration Date /, 6
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
13. Siding house
14. Estimated cosc- �
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature Jresponsible app,tcant
Remarks
i0 O o
-
B 6 � �xsaxcflnsatta
�F IM,
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATTON INSURANCE AFFIDAVIT
(licenserJpermittee)
with a principal plaae of busmess/residence at-.
v�
3 7C
hone
(stretit/cityhsta.trl zip)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am art employer providing the fo'-.lowing wor�xr`s compensation coverage for my
employees wo6ang on this job:
(Insurance Company) -- (Policy Number) --- (F_xpiration Daze)
( 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:
c
(Name of Contractor) (Lasuran(" Company/Policy Numbci) (Expiration Date)
(Name of Contractor) (Insurance Company/PoLicy Number) (Expiranou Date)
(Name of Contractor) (Innurinc C.nmn;l 7,fPolic:y Nnrnh.zl (Expiration Date)
(Name of Contractor) (1nau-mce Company/Policy Number) (Expiration Date)
(anadh-kRiomd sheet fncccsvry to inc}udc infoamstion pc� o all wiz aciora)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:plc=be aware that while homcowncra who cmpl oy pc"oas to do m atca*jcr�construction or repair work on a dwelling of
not mono than tbroo unit:is w ich the homcownct-rides ox oa tbo grounds appurtenant tha,:to arc not gcocrallY oowidcrcd to be
emPloYcra under the wa:ica's compa= ou Act(GL152s31(5)�application by a homcowncr for a licm3c'oc Puu):d may evidence tho
legal ststus of an employer undar tbn Works et CompemaLioa Act
I un&rstand tbst:L copy of this cial=cni miy bo forwarded to tbo Dcpattmcot of Indu d Aoadm&Office of Insw-woo for tbo
eoverxgc verification and that failure to acctuc ooverago tnxter suction 25A of MOL 152 can Icad to tbo imposition of aiminal Penalties
of s fine of up to S 1,500.00 andloe im{xisoanxszt of up to ooe year and civil penalti a in the foam of a Stop W ark Ordtr and a
fim of 5100.00 a day a&insi mo.
Far dcpartmeotaf use aaty --
/ Permit Number
2vtaP# _Lot#
S of LiccnscelPetmittee — �
FILE # v o_s 1 ��
Mgm T/CONTACT PERSON: ay J %p7� �(_
cp1'n�
#�DDRESS/PJJONE: 6 a
PROPERTY LOCATION:
MAP /_'17C__ PARCEL: ZO
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION_CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM ER.I.ET) OUT
Fee PAid
]Rnildin2 Permit Filled nilt
s -- �-
Typt, of Cnnctriirtinn-
TPZFOLLOWING ACTION HAS BEEN TAKEN ON THIS APPEICATIOM
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
S e11 Water Potability-Bd Health
e it from Conse n Comm• on
ZG 9
Signature of BuildAlnspector. Date
NOTE •�' fi "•''a
c dy. ;knot relieve an applloant's burden to oomply with all
_ zonlri-_-ired permits from the Board of Health, Conservation
Commission, Department of Pubiio Works and other applioable permit granting authorities.
s
Department: Reference No: BP-1998-0011
...................................
Building, Electrical & Mechanical Permits
..........................................................•---........
Fee Type: Receipt No:
Vinyl siding REC-1998-000014
aid By: Paid in Full On:
John Walz Wed May 20,1998
.............. - ............. .........
Received By . ...- N
Check No::- ••--. .....-•-.....-•-...
Linda Lapointe 3284
..--------•---------------------------------•------......................................
......................................
DEPARTMENT'S COPY Amount: $20.00
...........................
DEPARTMENT FILE COPY 51 LILLY 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: &q5 Inspector: Tracking No.: Fee:
20 May, 1998 BP-1998-0011 Stanley Szewczyk 963543 $20.00
GIS #: Map Block: Lot: Address: Zoning Use Group: Lot Size:
1867 17C 269 001 51 LILLY ST URB 9757.44
Contractor: License Type: Insurance:
John Walz
Address: License No.: Insurance No.:
66 Brady Street
Libu State: Zip Code: Phone:
CHICOPEE MA 01020 (413) 592-2376
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1998-0013 $7,675.00
Description of Work:
Install vinly siding
GeoTMS®1997 Des Lauriers&Associates,Inc. Signature:
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