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Zoning
Miscellaneous Additions, Repairs, Alterations, etc. Tel. No. Ci Y `/- ? 3 7 Alterations
%r NORTHAMPTON, MASS. A/00I/ -- v�C) 1 q 7,7 Additions
;, `` APPLICATION FOR PERMIT TO ALTER Repair
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Garage
1. Location / Y l // ' �' ( t4 L- k a '/ ) Lot No.
2. Owner's name .Z Cot/ A..1 y F Address r in 5
3. Builder's name Toe I ,i s .r Ad 5 4-,' Address t / r . i r /AID h 0 - 1 )
Mass. Construction Supervisor's License No. 0 5 7 0 Expiration Date
1. Addition
y ,
5. Alteration a_ .: . or. ♦ • fi -
t. . ` - �
r e i
5. New Porch
7. Is existing building to be demolished?
3. Repair after the fire
). Garage No. of cars Size
1. Method of heating
1. Distance to lot lines
2. Type of roof
3. Siding house
4. Estimated cost:-
_
G '�U U The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible appnicant
remarks _ . �1 .. .c& i . _._►.
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— �_ DEPARTMENT OP BUIWITIG INSPECTIONS _'` f
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N10\i O 1 212 Main Street ' Municipal Building
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N rth pton, M ass. 0106 0 tttr •
WORKER'S COMPENSATION NSD1t NC A J!n)AVrr
I, w• 714/).V>.-------"'" �
(li ttinscri tree)
until a principal place of business/residence at:
1t %/410 - ) R 9 A/ n, yi ot∎- Pi 4(phone /f) 7 ti- U 30 7
(sh ty /staldn p)
- 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 Dare)
•
( ) 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:
-'4 (Name of Contractor) (lns-rancc Company/Folic! Number) (Expiration Date)
(Name of Contractor) (1.ns ancc Compaawpoticr Nruaccr) (Expiration Date)
(Name of Contractor) (1nsuranc Company/Policy Number) (FX-piration Date)
(Name of Contractor) (Insurance Comoany/Policy Number) (Expiration Date)
(attach ariiitioaal aScct if nc«aary to incluck informiico pestinint, to all ooa raaors)
I am a sole proprietor and have no one worl•dng for me.
( ) I am a home owner performing all the work myself.
NOTE: please be aware that vtilo bomcouocrs N'.w aiaptoy per ons to do m.;nre ,, • ,, •, coostructiocror repair work oa a ds ellioy of
pot tnoco than tbroo units in which the bomoowocr rcaia , oc on the grounds appurkn_at tbceto arc pot (cnrralty oomidcaed to be
employ-co under tbo worker`: ocarpccsatiou Act (GL1S2,ss 1(5)), appliaDon by & bomcowo r for a lic asc oc permit may evidence the
. legal dataa of an omploy.r under the Worker's Coo>pooaation Act
I ondgata td that a copy of.thii ml®aut may b. for pm:da d to the Dcp.rtm,at of loduutaial Aoe:dmh OfSoo or Issaur oo. foe th.
covange verificstitw and that failure to scout coverage uodcr soctioa 25A of I.IOL I5i as kart to the impo itico of crimiasl pcatltic
000sistiug of a -Sac of up to S 1,S ,00 andlor impriaoeaocett of tip to one year and avt7 penalties is the form of a Stop Work Otdcr sod a
frno 4:1(3100.1:X3 a day sgainst toe - •
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For dcp. rhea at WO only .
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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 Building 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
# f Loading Docks
Fill:
-( volume -& location)
13. Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
DATE://— - Q' 8 APPLICANT'S SIGNATURE ,,7 �,��,1
NOTE: Issuanoe of a zoning permit does not relieve a appli a nt'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.
FILE #
Nov 2 0 ;mss ' 9 ■
File No. A v �
ZONING PERMIT APPLICATION ( §10.2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: :5 e j 4 s7A/s -
Address: i i ti -� s /��. I) , 4m r rc V Telephone: /i 3- re 2 /- a 6 7
2. Owner of Property: J c r✓cln r y
Address: f/9/A. T r Telephone: S 7 Li - ,) ? 7
3. Status of Applicant: Owner Contract Purchaser Lessee
Other (explain): ('- „trTi14cT7;/7
4. Job Location: /, -' rf F/1 i/1 ? G fl C, u .c - I))
Parcel Id: Zoning Map# P arcel# District(s): / / /f-d
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5, Existing Use of Structure/Property 4/L7 /? X kr 51? - 3
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets ifessyy):
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 PermitNariance/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 A 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 # BP -1999 -0533
APPLICANT /CONTACT PERSON Joseph Jasinski
ADDRESS /PHONE 115 Island Road(413) 584 -0307
PROPERTY LOCATION FAIRGROUNDS
MAP 25C PARCEL 251 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ,,,,������ r/
Fee Paid lye° ,yam`' -
T • e of Construction:
New Construction C 41-2/
Non Structural interior renovations ,/ /Y ( ,
Addition to Existing t ��
Accessory Structure
Building Plans Included:
Owner /Occupant Statement or License # w/
3 sets of Plans / Plot Plan
THE LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
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
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commi
Signature of Building Officia 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.
Department. Reference No: BP-1999-0533
Building, Electrical & Mechanical Permits
Fee Type: Receipt No:
Non structural interior renovations REC-1999-001452
Paid By: Paid in Full On:
Joseph Jasinski Tue Nov 24,1998
Received By: Check No:
Linda .Lapointe 1920
DEPARTMENTS COPY Amount: $40.00
DEPARTMENT FILE COPY FAIRGROUNDS
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: Inspector: Tracking No.: Fee:
BP-1999-0533 $40.00
GIS #: Ma I Block: t: Address: Zoning: Use Group: Lot Size:
, , *
9398 10' - 4- , -11 FAIRGROUNDS URA 871200
Contractor: License Type: Insurance:
Joseph Jasinski CSL
Address: License No.: Insurance No.:
115 Island Road 057025
City: State: Zip Code: Phone:
NORTHAMPTON MA 01060 (413) 584-0307
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0042 Non structural interior renovati $650.00
Description of Work:
INSTALL CEILING (OLD BEERHALL)
GeoTMS® 1997 Des Lauriers & Associates, Inc. Signature: