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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
ikr:%� NORTHAMPTON, MASS. /`��°'� Additions
(v.
APPLICATION FOR PERMIT TO ALTER Repair_.
yy Garage
1. Location 1/ g 7'-/02 gA)G L 0 L> t IP/a- Lot No.
2. Owner's name a-6 io hi i e.6I C/e-c Address /i' F70 ie c-t-)G C Uoil 26---e®S, /A-'
3. Builder's name 23¢ 5-40,)0a ,S =,1.--)0 C Address "g1 Az) cp. ,&P 14)P.1-4 4 m �IU MALI
Mass.Construction Supervisor's License No. d�FS 1f 6 Expiration Date 0)M),7 c O'
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
13. Siding house —y/00 Y r es-ie/)06
00
14. Estimated cost:- ',.5-06
The undersigned certifies that the above statements are true to the best of his
knowledge and belief.
Signaiur of responsible appiicanl
Remarks
•
9� r p �LZ art 1 &mpthn 1
___. . —
$��:i.v1/ -/,�•P i JAN ' A 2'i'�' yrlassarbuselS 1—
' "L 1.r DEPARTMENT OP BUILDITjG INSPECTIONS '� _ �i=
Qf 'z' 212 Main Street ' Municipal Building '0�ti=1 ��'.
Northampton, Mass. 01060 V
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
1, e 4 42 .5 46I ,v 6 J t_ ,2 .N C-
(li censee/permi ttee)
with a principal place of business/residence at: /
7 l ' �,, dj-n kie /�1/l x-54) �l, (phone#) � E'" � b7
( city/state/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:
e,5 7 xep C,.. .5-04z,fr maxis /060v aao A o_s--/s-;0Q0
(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 shoot ifnecoadry to include information pertaining to all factors)
( ) I 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 who employ persona to do maintrn.nr',masmuxion or repair work on a dwelling of
not more than three units in which the homeowner resides or on the grounds appurtenant thereto are not generally considered to be
employers under the wotket'a compensation Act(GL152,s 1(5)),application by a homeowner for a license or permit may evidence the
legal statue of an employer under the Worker's Compensation Ad_
I understand that a copy of this statement may be forwarded to the Departmcot of Industrial Accidents'Offioo of Insurance for the
011ak coverage verification and that failure to secure coverage under section 25A of MAIL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to S1,500.00 and/or imprisonment of up to one year and civil penalties in the form of a Step Work Order and a
fine of 5100.00 a day against me.
For do sae only
p ,/� Permit Number
EA.— 4 r.l.c,a I4,,, ao t, C? Map# Lot#
Signature of Licensee/Permi r7 ate
•
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:_
I1. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUB 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:
{volume -& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: /ne t 00 o APPLICANT's SIGNATURE j
NOTE: i anoe of a zoning permit does not relieve an applioants burden oompty with &i
zoning requirements and obtain all required permits from the Board of Health, Conservtation
Commission, Department of Publio Works and other appiioable permit granting authorities.
FILE #
r o
-cm; 12 , . 7,
l\ 4 � Fi 1 e No. 3
;n� y
<vE{gt4+
l or-P, z PERMIT APPLICATION (§10 . 2)
. _.- PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 73,'le s%,O),tX?- 3 1�Ne — Chu)r '.i L /3 eAt7r
Address: 22/ 8ta, el / /1/44 4 7016,0 /4'" Telephone: 414-W 7
cf'2. Owner of Property: V6 AA )0 i Ku c7ei2)
Address: 119 -/16� o4" RI I eev i Telephone: So
,./ S�
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# /./e Parcel# 3 District(s): ,//d
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
y.1 N11 S/o,06
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 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)
118 FLORENCE ST BP-2000-0663
oak,GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 11C-003 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: vinyl siding BUILDING PERMIT
Permit# BP-2000-0663
Project# JS-2000-1213
Est.Cost: $4500.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: B & R Siding 100465
Lot Size(sq.ft.): 8450.64 Owner: MIKUCKI VIRGINIA R ET AL
Zoning:URA Applicant: B & R Siding
AT: 118 FLORENCE ST
Applicant Address: Phone: Insurance:
781 Bridge Rd. (413) 586-4167 Workers Compensation
NORTHAMPTON 01062 ISSUED ON:1/14/00 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL VINYL SIDING
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
, R 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 1/14/00 0:00:00 16897 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo