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31B-310 (3) a -p o > .: zi 1:1 CT1 © m co = O r' N — R NO z = I. C7 -i y C ,•q' m r ° a 1 Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations %r NORTHAMPTON, MASS. t " APPLICATION FOR PERMIT TO ALTER 19 ?Ef Additions Repair Garage 1. Location 1 I 97)--6 ST Lot No. 2. Owner's name kr,k/i-� G Mt( Address 'L IO (-t 2 L � k( (�( ' 3. Builder's name U c 0 P *- ,,c, Address 3 33 6 t � �d .ee d L ektrt` Y Mass.Construction Supervisor's License No. CS G 3 1.7 7 Expiration Date t.° / ') 19 7 4. Addition 5. Alteration li 0-u-1 f-451)6 6. New Porch 7. Is existing building to be demolished? A)0 8. Repair after the fire A) l✓ c 9. Garage No.of cars Size 10. Method of heating 11. Distance to lot lines 12. Type of roof S AA (, P CVO i'v' 13. Siding house 14. Estimated cost- (.0 0 600 �1 The undersigned certifies that the above statements are true to the best of his, her knowledge and belief. 1-3‘,1-CO f G l Signature sl=rat ruthIe app+weant Remarks _ T • �4� Crzff ttnt f1�n =*__.s1 ?,..`.- �;' 1�' ' MAY 2 X99 . a I l tl 1:14, Axsaxcansctta -� _ I�w yam'. DEPARTMENT OP BUILDING INSPECTIONS 44 T i= . 212 Main Street * Municipal Building � Northampton, Mass. 01060 '", r WORKER'S COMPENSATION INSURANCE AFFIDAVTT L, '�/ . -a — t " c_.- (li censee/permi ttee) with a principal place of businesslresidence at: 7O c2'4,9///GA' 'Aillr C z-- �J o (phone#) /-7y ---�&7/ .-7- (strnct/ci• /stale/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: A '4e. . espy /C��3ye o, - - - . ..ceCompa.ny) (Policy Number) (Expiration snit) ( ) 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) (Lnsurance 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 a.dditioma rhect ifnoccauy to include iafocmaboa pn-t_g to sll 000t-o_don) ( ) I am a sole proprietor and have no one wording for me. ( ) I am a home owner performing all the work myself. • NOTE:please be aware chit mini()homeowners who employ Reno=to do °e.Or Mcgdr work on a dwelling of not mo'ro than tomes units is which the boq eowne rides or on the grounds zppurtenant tbescta an not geocr11ty oomidacd to be employers tinder the worker's coa>patsatim Act(GL152ss 1(5)),application by a.homeowner for a liccase cc permit may evidence the legal datat of act employer=dortbo Wocicoet Compcmatiaa Act I undt:cstaad.Lost a.copy of thin chtcmcaL may bo foiwardad to Lilo Depa b cot of Ioctustriel Aeadeao!OLSoo of rmurLoco for Lho coverage verification and that failure to socure coverages under section 23A of MOL 152 eau lead to toes'imponfion of criminal penalties ,,r coaiisiing of a•fine of up to 51500.00 and/or imprisonment()flip to one year and cavil penalties in the form of a.Stop Work.Order. and a fine of 5100.00 Idly against toe. ,, //'� Far dryatmr al itao only GJ -ttcc y i / Yj. _ iga.iire of Lic nsc eer . 10. Do any signs exist on the property? YES NO kLIVVOL- IF YES,describe size,type and location: Are there any proposed changes to or additions of signs intended for the property?YES ,_ NO X 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 - front - side L: R: L: R: - rear Building height Bldg Square footage %Open Space: (Lot area minus bldg &p=eed parking) # of -Parking Spaces # rof Loading Docks , Fill: -(volume -Sr location) 13 . Certification: I hereby certify that the information contained herein G is true and accurate to the best of my knowledge. DATE: � AF�T�� � s SIGNATURE NOTE: iss ane of a zoning permit does not relieve an applicant's bu den to oomply with oil 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 # MA File No. 933--7/// 1 ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: F( fa yr✓ O Address: -3)) z/i►t4M Telephone: `Ccv S 2. Owner of Property: (\N(I a 'e l 5 4 �SDC - Address: 4 5S0 40U-v) )(' Telephone: 3 S 56 o 1-Y 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): 4. Job Location: .:> Loud-0 St Parcel Id: Zoning Map# , '/ 13 Parcel#1/4-3)e) District(s): G(TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property O65 6. Description f Proposed Use/VVork/Project/Occupation: (Use additional sheets if nec ss : • lirV\ — ii "24-aD /1-1 e it.)-e.4_-5- f- 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 X 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 FILE # ., ,; i. og MAY 2 8 39 APPLICANT/CONTACT PERSO ,.fit (a ie/it-G 3 �c�/rte .� ADDRESS/PHONE: 6 1,,, v_ / - _ .4ee- _ 0 O PROPERTY LOCATION: 7/,/,�, GAP(s2 — !°� 4 -( e_,1_ -- PARCEL: 310 ZONE &22,-e__- MAP �� /� THIS SECTION FOR-OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM VII J FT) OTTT 1.---"" Fee Paid / Building Permit Filled not ✓ Fee Pair] 79 t e2"T0"` t---- New C'nnctrnrtinn �� I , -e1-t1--- Remndeling Tnterinr 1•j pettea q• Additinn to Existing Arreccory Strurtnre Building Plans Tnelnded• Owner/Occupant Statement n .hence#> 6,56 17 7 7 3 Sets of Plans /Pint Plan — T OLLOWING 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-Bd of Health Well Water Potability-Bd Health P it fr Conse o, o e■ a moron f6/2:115 Signs e of Building Inspector Date NOTE:issuenoe of a zoning permit does not relieve an applloante burden to comply with eli zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Department of Pubiio Works and other applioeble permit granting authorities. r Department: Reference No: BP-1998-0035 Building, Electrical & Mechanical Permits Fee Type: Receipt No: Roofing REC-1998-000038 Paid By: Paid in Full On: Titan Roofing Wed Jun 03,1998 Received By: Check No: Linda Lapointe 7950 DEPARTMENT'S COPY Amount: $240.00 DEPARTMENT FILE COPY 71 STATE ST 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(M 142A) Issued: Permit No: 02( Inspector: Tracking No.: Fee: 02 Jun, 1998 BP-1998-0035 Stanley Szewczyk 963591 $240.00 GIS #: Map Block: Lot: Address: Zoning: Use Group: Lot Size: 9608 3113 310 001 71 STATE ST URC 90735.48 Contractor: License Type: Insurance: Titan Roofing Address: License No.: Insurance No.: 70 Orange St City: State: Zip Code: Phone: CHICOPEE MA 01013 (413) 536-1624 Project No: Category of Work: Const. Class: Cost Estimate: JS-1998-0036 $60,000.00 Description of Work: install EPDM roof Geo7MS41)1997 Des Lauriers&Associates.Inc_ Cirm rn•