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Zoning
Miscellaneous Additions, Repairs, Alterations, etc. Tel. No. Alterations
: NORTHAMPTON, MASS. �)�t`k�-An 1 \ 9� °"
Repair Additions
"� �?s
;. } APPLICATION FOR PERMIT TO ALTE
Garage
1. Location i . ry\A -9L- N t Lot No.
2. Owner's name h G &A- M N -4 11114 owl C 2__ Address /S A Fti G izoikcr``
""";. Builder's name D2`ZRU \L M T. ' — ZC'J Address, -23a? / 6-Ydnv U tece (.t-t1.i - 0 iD `9
Mass. Construction Supervisor's License No. 0 / \CI Expiration Date 200 2-
4. Addition
5. Alteration ..r t...ST,hu.,t c-th -- 1 ■)CX.t) L.1) Lea f.- Pozc (n, cQco
6. New Porch
7. Is existing building to be demolished? N 0
8. Repair after the fire N AA
9. Garage ! v e` No. of cars Size
10. Method of heating .A/ IA-
11. Distance to lot lines 20 l
12. Type of roof s ),-,, 6 t - ,
13. Siding house rill /
14. Estimated cost - 4 , [., ,
The undersigned certifies th the above s ments are we to the best of his, t
knowledge and belief.
al 'S ' a-'i -
Signature of responsible appicant
remarks
:2:7 Rd '*ate
i � �� M rs o M r' '` of Norft antp f an 1 = * _ u
9 t •s y . V ,P V 1 . 5 u 1'\ JRamine/pistils _: _
V ier f ...— i c.: ..1.,; .:: i -r- t �;IL..:S:J `
10 , ' ‘, DEPARTMENT OP BUILDING INSPECTIONS e.,44 � _`' j=
. 212 Main Street • Municipal Building `�, - `` w
.,,,`, ,?' "' Northampton, Mass. 01060 0 ` Q
Dtil t) '313 WOR� R'S COMPENSATION INSURANCE AFFIDAVIT
1, 1 l2._ckss ci U ( 'II i , L-43-(v.
(licensecipermittee)
with a principal place of business/residence at:
3G N 4-'1 49 1-6) ,itp f WW1-Ter/Ai 41— (phone #) �o S ?S ` Y
(street /ci
do hereby certify, under the pains and penalties of perjury, that
( ) 1 am an employer providing the following worker's compensation coverage for my
employees working on this job:
( Insurnce Company) (Policy Number) (Expiration Date) •
K 1 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 additiooal:bort if:towssary to include information pertaining to all ooatectoss)
( ) 1 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 that while homeowners wbo employ persons to do tin d^+n1 e, comtructicerar =pair work on a dwelling of
not mace than thnos units in wbichttae homeowner resides or on the grounds appurtenant tbee to ass act generally oomideted to be •
employers under the wakes ooa pensatioa Act (GL152,5s t(5)), application by a homeowner fora license or permit may evidence the
legal status of an employee undertbe Wedroi'a Compensation Act
I uaderstaodthe aDopyofthis ststemeatmay be forwarded to the Dopartmcot ofIndustrial AceideatiOlsoe oflnsuraooe for the
coverage verification and that failure to secure oovcrago under section 25A of W 1L 152 can lead to tbee impoeitioa of aimioal penalties . .
oomistiog uptoS1,500. 00sad/ orimpr iso® eatofuptoone year and eivtlpeaattiesintbe roan ofa Stop %y kOrderanda
fine of S100.00 a day against toe. ..
- Fardepataesotal use only
/1 / , At„ 1-4 ad sorb N .
S' "-T' ' a fLieensee/Permittee
' q
5 •-
-2
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
of Loading Docks
Fill:
{ vol -ume -& location)
13. Certification: I hereby certify that the information contained herein
is true and accurate to the best of my kno ledge.
DAVE: / /1 GG APPLICANT's SIGNATURE /� 4 k ; ,
NOTE: Issuanoe of a zoning permit does not relieve a a - • ' oants burden to oomply with r all
zoning requirements and obtain all required permits f • m the Board of Health, Conservation
Commission, Department of Publio Works and other - pplioable permit granting authorities.
FILE #
[ TROT E
,P axe tl
Fil No ' ,0q'e✓ f
"FPT OF BiS ' ` �, iNSPECT�IONti>
PERMIT APPLICATION 2)
P LEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant::) s 0:5.3 � `��1Z:c U LLAc c--t
Address (o 1-140 eKk.i �(.@ . �� � 1 (�(lIi1A- f11. 4- Telephone: l ik3 Ce CPS' - 7S 87
2. Owner of Property: 1�f2. /1 N 1Z ) 11 Au, vttl IC Z_
Address: 1 f \e . - ( i2 ivN C Telephone: ccg L.3 9 -- )S
3. Status of Applicant: Owner Contract Purchaser Lessee
IN Other (explain): 0�,0,T01
4. Job Location: VS (YVtG
Parcel Id: Zoning Map# 693 Parcel# d6 District(s): / /b4./et-
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property l kt.c C�
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
A (: ' 'QAcvh �- 11 wt V LF -
`�Zeplact� v +- c>? Oe�r r�ctl� �3� "(Log—
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 pS 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 )S 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- 2000 -0658
,em APPLICANT /CONTACT PERSON JDR BUILDERS
ADDRESS/PHONE 236 HAYDENVILLE RD (413) 665 -7587
PROPERTY LOCATION 15 MAPLE ST
MAP 23A PARCEL 256 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid ,75
Typeof Construction: REPLACE 30" PORCH DOOR W/36" DOOR, NEW FRAME & HEADER
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 074104
3 sets of Plans / Plot Plan
THE LLOWING 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 CommOto
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.
r � .
15 MAPLE ST BP- 2000 -0658
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23A - 256 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: REPLACEMENT DOOR BUILDING PERMIT
Permit # BP- 2000 -0658
Project # JS- 2000 -1201
Est. Cost: $230.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JDR BUILDERS 074104
Lot Size(sq. ft.): 5140.08 Owner: NAUMOWICZ PAUL J & THERESA M
Zoning: URB Applicant: JDR BUILDERS
AT: 15 MAPLE ST
Applicant Address: Phone: Insurance:
236 HAYDENVILLE RD (413) 665 -7587
WHATELYMA01093 -0066 ISSUED ON:1/26/00 0:00:00
TO PERFORM THE FOLLOWING WORK: REPLACE 30" PORCH DOOR W/36" DOOR,
NEW FRAME & HEADER
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
,O lgiva ' 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 1/26/00 0:00:00 269 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo