18-013 PIONEER SPORTS i
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NOV 1 71997
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Van's Pioneer Sports
In the old Caldor building Storage Storage area
Northampton,Ma
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I Sub-renting area \ ,
�ol Arrow shooting range
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Retail area
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
a NORTHAMPTON, MASS. 1 q Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
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1. Location � Am d, I Vii S-/ �+°aWA J��1 a . 1alo Lot No.
2. Owner's name Vill VA Address Y4 J4 4,f
3. Builder's name ?AULAC,IE/L �Y���C`r/�� l��' > Address la` 10 ,V 4 r It ' Ut ' e-a'
Mass.Construction Supervisor's License No. D! lv��' Expiration Date
4. Addition
5. Alteration i^ ttC¢wsfCe��Cd —/ b3 LczU' Cz )
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 cost:Af 2,:W,1-v
The undersigned certifies that the above statements are true to the best of his, her
kn and belief. ,
Signature of responsible app<<cant
Remarks
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0 (rid of Jgort4aillptoli
NOV �r<�:ttrhasrtls
DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSMANCE AFFIDAVIT
?401 tEC&FEC
7,� (licensec/permiuee)
with a principal place of business/residence ax:
,YT lam` 7-. Cato (0 ct . hl, 1), 010 (phone#) Y/_�s-.?-A-- 3 Y�J—
T (street/city/statr/ap)
do hereby certify, under the pains and penalties of perjury, that:
(4'I am. an employer providing the following workers compensation coverage for my
employees working on this job:
j WC 00 ApJ00
iv c 3.}-1 -3 j -o f
(Insurance Company (Policy Number) (Expiration Daze)
( ) 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 Comparry/Policy Number) (Expiration Date)
(Name of Contractor) (insurance Company/Policy Number) (E)#ration Date)
(Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date)
Ott h ad&tiomd sbost ifnocea.uy to iac a informitioa perariuin to nU cow actors)
( ) I 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 tiKt while homeowners wbo ernploy paaom to do mi„r,�a„n cc-&"eioa or repair work on s dwelling of
not mono than throe units is which the homeowner raids or oa the grounds appurtenant tb=w arc not generally ooa-kftd to be
employem under the works':oompcnsatioa Act(GL152,ss 1(5)),application by a homeowner for a license oe permit maY evidence the
legal status of an employer under the Workves Compemation Act
I understand that a copy of thin statement may be forwarded to tbo Depactm..d of Ind,>sstrial Accidents'(woe-f I-'j'°Ce for the
coverage verification and that fail=to senor covemp under soctioa 25A of MOL 152 can lead to tba imposition of criminal penalties
oornistiug of a fine of up to S1,500-00 aallor imprison of up to one year and civil pc nitics in the form of a stop W oric order and a
fino of 5100.00 a day stint me.
S1 ed this 17_day of )W&L,4L, 199.7 Foc d imtat use only
1 Permit Number
C �L Map#t Lot#
Signature of Lic=z;ceRerinittce
t
10. Do any signs exist on the property? YES NO
IF YES,describe size,type and location:_ A10 l::4yc-
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Are there any proposed changes to or additions of 4igns intended for the property?YES NO
IF YES,describe size,type and location:
11 . ALL INFORMATION MUST BE COMPLETgD, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
T2US column to be filled in
by the Building Department
Required I
Existing Proposed By Zoning
Lot size
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Frontage
Setbacks
- side L: R: L: R:
- rear
Building height
Bldg Square footage .2 e4L."
%Open Space:
(Lot area minus bldg
&paved par king j
# of -Parking Spaces
# '6f Loading Docks
Fill:
-(volume -& location)
13 . Certification: I hereby certifythat the information contained herein
(11 is true and accurate to the best of my k ge.
DATE: It- �)- APPLICANT's STGNATU �,,/, � 'i-�_
NOTE: luounnoa of a zoning permit does not: a ppliomnVs burden to comply with +111
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works ar d other applicable permit granting authorities.
FILE #
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71991
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File No. (!� a "fir
BONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:_ ✓Cl L) Ai
Address: i Aei )&IalTelephone: �V`� ��
2. Owner of Property: // t';4 4---,
Address:YA 44 , Telephone: q
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
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Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property c�
6. Description of Proposed Use/Work/Project/Occu ation: (Use additional sheets if necessa ):
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 i/al 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 f 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)
' FILE # 9 t y .*f i.l 3
APPLICANT/CONTACT PERSON: C `
ADDRESS/PRONE: , "k? 162o ,jam —
PROPERTY LOCATION:
N AP / PARCEL: 0 ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONMG,FORM FH,T,FT) OUT
Fee P-gid
Fee Paid �d,51
Type of Construction-
New Cnnstriirtinn
Additinn to Existing
3SPtqnfPlnny /Plnt Ian
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rOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
Approved as presentedfbased 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 Conservatio ommission
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Sign -e or ate
NOT Issuanoe a zoning permit does not relieve nn applioant's burden to oompty with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public), Works and other applionble permit granting authoritlas.
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A�° -may City of Northampton REQUIRED INSPECTIONS
1. Footings and Walls
BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
No. 1108
Office of the Building Inspector
Zoning Form No. 963031 Date 11/20/97 Fee$40.00 Check# 5051
Page, 18# Parcel 13 ,Zone HB/WP Section 127 ❑ Yes ® No
4-1� BuiiLDiNGPERmi r r
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Leclerc Brothers before Building Inspections
has permission to construct interior partitioning Inspection on Site—Foundations
situated on 184 North King St - Van's Pioneer Sports 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
Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON rITWWPRE ISES
Certificate of Occupancy
uilding Inspector