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Zoning
Miscellaneous Additions, Repairs, Alterations, etc. Tel. No. Alterations
%r NORTHAMPTON, MASS. 1 9 Additions
i APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location //gin S"T " -ff Lot No.
2. Owner's name , c 0 ,,,.,,, ,Y f -r4 ;7? Address , f X91 a TT
3. Builder's name foe .7 row f4 Address I /3 ,i-31,0 Ad4 R U
Mass. Construction Supervisor's License No. C S 0, ?C, oe',i Expiration Date ,42 001
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 TI /1 1
13. Siding house
14. Estimated cost: -
The undersigned certifies that the above statements are true to the best of his
knowledge and belief.
Signaturt of responssble app,ican1
Remarks 7k s IC 4 i i p taof 9 c r x - 0 L°la 92 - / » 1 Off' :44A-2-;1. iv.of
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"�::' DEPARTMENT OP BUILDITjG INSPECTIONS C
'all •
212 Main Street 'Municipal Building
Northampton, Mass. 01060 so
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, - " - cie J A ti 5 )
(IicensctJpermittee)
with a principal place of business/residence at:
3 c //US'I/4it C (phoneil) 5" $ of -a4 3 7
(bt.i cit /stalelzip)
do hereby certify, under. he 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 Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional suet ifnocenary to include iafocmatioa pertaining to all contractors)
( ) 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 *bile bomoowners who employ persona to do maiatenance, onistructionor repair work on a dwelling of
not more than three units in With the homeowner resides or on the grounds appurtenant thereto are oot generally ooasidercd to be
employers under the worker's compensation Ad (OL152411(5)), application by a homeowner for a license or pesaoa may evidence the
legal status of an amployer moor Me Worker's Compensation Ad.
I understand that a copy of tbia uatemed maybe forwarded to the Dopertmcot oflnduatrid Accident! O15oe ofimaa.00s for the
coverage verification' sad that falure to secure coverage under action 25A of MOL 152 can lead to tbd impoa"on ofaimmsl penalties
oomisting of a fine oft, to $1,500.00 and/or isupxiso=cat of tip to ace year and civil penalties in the form an Stop Workordrr and a
Sae of3100.00 aday against me. ..
For dep ttm:Maluseally
Permit Number , -
UP _ Z;t12.,- t,, --- Map# Lot #
' J - • 1 • errn1ttee Dalt
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 column to be filled in
by the Banding 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
# 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 :l1,l _Q'q APPLICANT 's SIGNATURE
NOTE: Issuanoe of a zoning permit does not relieve an pplio is burden to oomply with .a l
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Pubiio Works and other applioable permit granting authorities.
FILE #
�.5
NOV f 2 1999
Fil No. 67
ZONING PERMIT APPLICATION ( §10.2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: -.f ; a _` ° ) A S7 /t 1, a
Address: 1/ T , r c f? Telephone: 3 r C (
2. Owner of Property: ' ti 1 r.. " ) 1
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other (explain): -vr'2
4. Job Location: (Li f t t- , ... . ;f' � , (7 r -)7;))?
Parcel Id: Zoning Map# oJ Parcel# 0 District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property ' i n
6. Description of Proposed Use/Work/Project/Occupation:: (Use additional sheets if necessary):
7 J, i f i ti 41 Y 1 6 A /I Lam 1 T fi" J' ,iPt ;) ? n 9 C11 k c f ' J `✓ /'' F /L cep
S/ ; " ( ,} =1) f . J . l 1 ? )? UC
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 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)
1
CROSSPATH & FERRY RD BP- 2000 -0514
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map :Block: 25C - 251 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: roofing BUILDING PERMIT
Permit # BP- 2000 -0514
Project # JS- 2000 -0891
Est. Cost: $5000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Joseph Jasinski 057025
Lot Size(sq. ft.): 871 200.00 Owner: HAMPSHIRE FRANKLIN & HAMPDEN
Zoning: URA Applicant: Joseph Jasinski
AT: CROSSPATH & FERRY RD
Applicant Address: Phone: Insurance:
115 Island Road (413) 584 -0307
NORTHAMPTON 01060 ISSUED ON :11/17/99 0 :00 :00
TO PERFORM THE FOLLOWING WORK: SHINGLE HORSES BARN ROOF OVER
EXISTING 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 Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 11/17/99 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo