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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. Ge-t IS Additions
' APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location U Aoftta t./yt au-&: Lot No.
2. Owners nameT C' �esiE. Address Aa_ A
.g� �/ ,�.
3. Builder's name..?j4 VAAMMI Address l'22am/t�I
Mass.Construction Supervisor's License No. e3 P#.2.G Expiration Dater_ a�
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 QA&K.V-er,,-9A.'41.
13. Siding house
14. Estimated cost:- rlg �D rd
The undersigned certifies that the above statcmcnts are true to the best of
knowledge and belief.
Signature of responsible applicant
Remarks
q. f
4'Ct►N'1P)•
° OCT i 9 1999
s e ; it-R of Xarf 4ampf u w
$ B � �laasachnsctta
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"DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMTENSATION INSURANCE AFFIDAVIT
L QW ��leuM.
(licenset•Jpermittee)
with a principal place of business/residence at:
17&v leT-c � N24� - _(phone#) .r-9� t�
D street/city/state zip)
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:
(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 Comparry/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additioosl sheet if necessary to include information pertaining to all ooatmd )
(.4/1 am a sole proprietor and have no one working for me.
( ) 1 am a home owner performing all the work myself.
NOTE:please be aware that whilo homeowners who employ pe¢sons to do rn rn___ate o=&uctioa or=pair work on a dwelling of
not more than three units in which the homeowner resides or on the grounds appurtenant thado are not se wally owsukrcd to be
employers under the worker's compensation Act(GL152,ss 1(5)),application by a homoowner for a lick or permit may evidence the
legal status of an employer under the Worker'&CocVeosauon Act
I understand that a copy of this statement may be forwarded to the Deputmcd of Lxhotririal Aooi4aa&Offioe of Invat—ce for the
coverage verification and that failure to seam coverage under section 25A of MGL 152 can lead to the imposition of Mmmd Penalties
oousisti of a fine of up to$1,500.00 and/or imppisonmeaL of up to one ycar and civil pcmlties is the form of a Stop Work Order and a
fine of$100.00 a day against me.
For dgMtmeat&1 use only
Permit Number
Map# Lot#
Signature of LicmskjPermittee Tate,
10. Do any signs ebst 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.
Thin corn 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
&paved parking)
# of Parking spaces
#- of Loading Docks
Fill:
4v0lIume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DA'Z'E: (-t. m en APPLICANT's SIGNATURE
NOTE: Issuano of a zoning permit does not relieve an applio nt's bu den o oomply wltla,,pll
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 #
OCT 1 9 1999 Ei s e No. �m
ZiON,TNG 'PERMIT APPLICATION (§10 . 2)
PI�E`AEE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: X1,17'�rausk/
Address:lj'j � ^ �d�jV� -- Telephone: .�'f7=9 X37
2. Owner of Property. . &,1A 0,rL
Address:49 da A&Lt Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: J3wlt .un.-�Q j, �,T1�� atoA o,
Parcel Id: Zoning Map# 0)�_ Parcel#_ District(s): �/
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)—
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Pro.ect/Occupation: (Use additional sheets if necessary): p ,
��r dV 10 543UM7 k Lt1i ¢��fi�ps�; _ _ C FC s'
r Vd r-( &27 Q0 2W -
—16
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 Perm it/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 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)
rl..-0 -0.
23 PIONEER KNOLLS BP-2000-0401
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29-045 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:roofing BUILDING PERMIT
Permit# BP-2000-0401
Project# JS-2000-0692
Est.Cost:$4850.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: W M Brown 038426
Lot Size(sa.fQ: 11979.00 Owner: ELLERBROOK RAY A&WENDY J
Zoning:URA APP licant• W M Brown
AL. 23 PIONEER KNOLLS
Applicant Address: Phone: Insurance:
177 West St (413) 247-9937
WEST HATFIELD 01088 ISSUED ON.•1011911999 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL SNOW & ICE SHIELD & SHINGLE ROOF OVER
L LAYER
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Final: Final:
Rough Frame:
Gas Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Sienature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 10/19/1999 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo