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DEPARTMENT OF BUILDNG INSPECTIONS
212 Main Street a Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
�i�ensa/per�i«ee>
with a principal place of business/residence at:
c�- (phone#)
s =t/city/=W2ip)
do hereby certify, under the pains and penalties of pedury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
ansuraAm 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 Conn-actor) (Insurance Compauy/policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(At,-A addition2l aficet if neocaary to include information pertaining to all ooatsadots)
( ) I am a sole proprietor and have no one worlang for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that vi ilc homeowncra who employ pasoat to do m_kdca mc,,c=ouction or tspair work on a dwelling of
not more than throe uads is winch the homoowncr rides or oa the grottads appuruawt thetcto are not generally ooaridered to be
employers under the wod='�%c oaTcasation Act(OL152,ss 1(5)),application by a homcow wr for a lloc=cc perma may-ida—tic
legal stabra of an employer coder the Woc$da Coarpam um Ad.
I understand fiat a copy of this ctatcmmt nuy be forwarded to tfio Deputmeot of Industrial Aoddeo&Offioe of Inwnooe for dw
oovaage verification and that failu=to teatre coverage undrx soctioa 25A of MOL 152 an lead to tin impca oa of aklind peaaltiea
comistiag of a fine of up to S 1,300.00 and/or imprismtmau of up to one year and civil pcaaltics is the form of a Stop Work Order and a
Sae x(5100.00 a day against me.
A For dcpa4nmtal use only
!!! o Permit Number
Mao _Lot#
S19nature of Licensee/Permittee
. 11/01/99 MON 11:15 FAX 413 535 5189
FROM - CHUCK-S S I MVS a 00 2
All} 423 594 4923
N Q(1 1999 11:31AM Pi
1�:U1-99 WIN it : :,; 1 :.S 145 5169
tQJUUi
Rey�air ( >
Plans musebe.filed with the7bulidn lrtispeccos,
beefore-a permit will be granted, Runoval...r._..__.......( )
Application ,for a -Permit to. Plice -or Maintain .a Sign
or other Advertising Device
'( vpl#eatioe to be filled out is ink or typewrittcn)
FFF.......... VAGE.......... P1,0T..........
Northampton, Mass.,..........
To the Building Commissioner:
Application for a permit�too place or maintain a sfgtx pr other advartisine dsyict, or r4aaquec•
............. .............. .....•.. . .. ......�, ....,......
1. LOCATION, STIR"T/����N//o.� c2.»7 ._ � ....J�a L.�_�� �_..... ....... __ .._......__
2. Owners name.__.._._, ..U/J
3. Opener's address....._. . . »_. Fs���T!:'ra. _. .... ..��°r. _ ..�..___„—__• _
4. Maker's naT»e__..__. .__._._. ._ _ _.�._. ... .._.„_.,.,».. ._,_... _.•.__w�.__.. . .-_.._..,.__„.. ,........
G. -Erector's name..................
.�k..4!..4.f�.5 ........_....
?. Erector's ......_...
ry..
SIGN KIND OF 51GN
(Designate)
1. Sign will be (chetk one) illuminated-„.,. ,,._non 41lurninA
2.. W.jlLsign,obstruet a fire escape;winnow ordo�?_ ..,_"w...
S. -Lower rrdge will be..._ _f.,�..•_ft.„..3•._ius.abo-je the Dublin wsy. $jrojac Ling..._.......,.._..,.._....
4. • iJp* edtra wil"l be;.._J.y..ft• ns,abm-e this pablie-W4Y- Rno��„._......._................._.....
s, ins. R%idch...»..�..__.ft,�ns. 'Teniporaa7:..✓,.._._.,,...._
6: Face areal�.,:,sq-. f t, �a�._.......... ......._.....
?.- . muter edge,will�*� _. �� in9 SYOm the building or pole.
Gaon>zd__..-..•.........•-
S. Ouker edE;e,wUl ba....,._/....._ins.from the bQ4ding or pole. �xr.".,....._�,•""`....,".....„
9. Face of building or pole-is.J.:O..9ns.back the straet line-
10. Sign will prof ect.__„,.�2_itts.beyond the Atreet line,
11.. Sign.will extend_._._��ft.__.,_......_.inec- above the buildixur[,� 'ole- pl
12. Of what rnatcriai will sign be co"ticted2 k�sIIle_ f7/J.all)l l j?L�. .. Faco....../J ri�', mac..•_
13. fistift%wecost...... •......
The unaersigmed oea'lifie3 that the above statement_- ors true to the
best”erf-hts�ta.�wl-eclS'e and belief. �r
tS:gnature of Owaaror Agentj
T _In order that thia aPptication may be accepted,, ed
epted the data Bai -for above must be set forth
1 E Y and>' amLy-
'
..
-_______--__.� --_�__-_____._____-'__�_'__ --________ -� .
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/]. ��~` n �� 1- / _____. l
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' _____----_- __ ___ _ __----- -__\__
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\ -.~-_ �_ � `~ _--_'__ _-__- __
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IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , date issued:
10. Do any signs exist on the property? YES NO / /
IF YES, describe size, type and location: � 5 1 h 5 a r) 9U t / Gr /
0n �' / l1C1dolCt S[ C/ �--- =
Are there any proposed changes to or additions of signs intended for the property?YES 0
IF YES, describe size, type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This column to be filled in
by the Building Department
Existing Proposed Required by Zoning
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height /
Building Square Footage 13
% Open Space: (lot area
minus building&paved parking
# of Parking Spaces
# of 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: �r _Applicant's Signature
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.
Fi 1 e No. —
ZONING PERMIT APPLICATION ( §1 )
BUILDING
PLEASE TYPE OR PRINT ALL INFORMATI N a�DEPT OF F N ,i k
**Please return to the Building Inspector's office with the $10 filYrig' ee c ec or
money order payable to the City of Northampton)*
1. Name of Applicant:_U H/1 4 IC
Address: -. c%7 /y / Telephone: y13
2. Owner of Property: 0-111 U L Re-a /0 le—
Address:
lV 4 rCc / 14VC Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use(Work/Project/Occup tion: (Use additional sheets if nece a ):
O �� l vM n f C� SryI
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW v YES IF YES, date issued:
IF YES: Was the permit recorded at the Re ry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
9. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES
(FORM CONTINUES ON OTHER SIDE)
y
File#BP-2000-0464
APPLICANT/CONTACT PERSON U-HAUL REAL ESTATE COMPANY
ADDRESS/PHONE 2721 N.CENTRAL AVENUE 6-$'6 a cf;L 3
PROPERTY LOCATION 227 NORTH KING ST
MAP 18 PARCEL 006 ZONE HB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildiniz Permit Filled o t
Fee Paid 1,fj94- 111,,13, '5195
Typeof Construction: EREdT ILLUM REAR WALL SIGN 29"X 47"-UHAUL
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Ap roved as presented/based on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under!§ Z J-3- � ' " �T
PLANNING BOARD ZONING BOARD S/0 ��¢� TiS��y✓
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 Board of Health Well Water Potability Board of Health
Permit from Conservatio o ission
5/lf,9
Signature of Building Official Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
OCT-31-2007 14:57 From:CAMPBELL 6172415115 To:4135e71272 P.1/2
CAMPBELL CAMPBELL EDWARDS & CONROY
PROFESSIONAL CORPORATION
TEL: 617-241-3000
FAX: 617-241-5115
FACSIMILE COVER SHEET
DATE: October 31, 2007
TO: Northampton Building Inspector
FAX NO.: 413-587-1272
FROM: Jason Brandenburg
CASE NO.: 1633-259
RE: Viewing all building records from 227 King Street, Northampton, MA
PAGES: —2—(including cover sheet)
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COMW,NTS-
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CONTAINS CONFIDENTIAL INFORMATION FOR THE PERSON(S)NAMED
ABOVE. ANY DISTRIBUTION, COPYING OR DISCLOSURE IS STRICTLY
PROIaBITED. IF YOU HAVE RJ--;CL-IVED'THIS TELECOPY IN ERROR, PLEASE
NOTIFY THE SENDER IMMEDIA'T'ELY BY TELEPHONE AT THE ABOVE
TELEPHONE NUMBER.