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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
k') NORTHAMPTON, MASS. y 19gJ Additions
APPLICATION FOR PERMIT TO ALTER Repair
/ Garage
1. Location 7 13 er riot of C A N 5 Z c /94 Lot No.
2. Owner's name /1`.5' On u e bi e U Address 7 /3 e j'",1 4t. Uh r 57- Le eat; pn s
3. Builder's name Lies r-r•,i A ea s; (3.,' ,`, . 41- Address G 3 6-.4 57 r• ;(0.0.9 "70.
Mass.Construction Supervisor's License No. /05'6 30 Expiration Date 77,2-O O G
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 5;6 9.--
14. Estimated cost:-. 5-700. a
/ The undersigned certifies that the above statements are true to the best of his, he
knowled: and belief. c
-.
e AurA,
Signature of responsible applicant
Remarks
;a ti fj`6lass�cllasctia 1� =
� }-4.�, DEPT 0 =r1=
'W r F st TIvf ENT OF BUILDING INSPECTIONS dh _';_�i
°'"*"----2,12- in Street • Municipal Building
Northampton, Mass. 01060 tom'
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, 0e/in IS' Z.c•-4:aT'0-
(licenstelpermittee)
with a principal place of business/residence at:
3 C..-a.5.7- �n e 7,, Sri /7-)x., (phone#) m-'6-" r-2 2 '"?
(street/city/statezip)
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 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 if necessary to include information pertaining to all oo trecto-s)
( 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)homcownm who employ persons to do maintenance,comtruction or repair work on a dwelling of
not more than three units in which the homeowner resides or oa the grounds appurtenant thereto are not generally considered to be
employers under the wodcees compensation Act(GL152,ss 1(5)),application by a homeowner for a license or permit may evidence the
legal staters of an employer under the Worker's Compomation Act.
I understand that a copy of this statement may be forwarded to the Department of Indastrial Accidents'Office of Insurance for the
coverage verification and that failure to scam coverage under section 25A of MOL 152 can ksd 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 Stop Worst Order and a :1:
fine of 3100.00 a day against me..
C�_ For use only
�, / / Permit Number
'a(_. /�' / 7 Map#• Lot#
u:
Signature of Lie nseeJPermittee '0�-
•
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:
-(volume -& location)
13 . Certification: I hereby certify that the information contained herein
G is tru- a d accurate to the best of my know edge.
DATE: y
APPLICANT'S SIGNATURE -,,,„,„' t
NOTE: les anoe of a zoning permit does not relieve an applioants burden to comply with Y ell
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public, Works end other applicable permit granting authorities.
FILE
i l J ,
JAN 41999 it/YgoR
OF Sty ',�F,,;, l`}
File No! '�� i
"..m °Z NI G PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: �, c�i'vr - „ : Ar . o
Address: q 3 (qT 5 r .-r.,0„.0,70.-" A,Telephone: 5-3-C- S`.7 .Z 7
2. Owner of Property: 1/ 0 t er,-Jrj
r IS--Address: 7 Uev�iz, 1 .CT I- e r Telephone: :s'r$`-- -oce y [s
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: 7 /5e-1 c 57� 7-- Le oC/J G
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)r
5. Existing Use of Structure/Property go PP;e
6. Description of Proposed UseNVork/Project/Occupation: (Use additional sheets if necessary):
3fdJ -
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.
S. 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)
7 BERNACHE ST BP-1999-0613
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 1 C-010 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: vinyl siding BUILDING PERMIT
Permit# BP-1999-0613
Project# JS-1999-1164
Est. Cost: $5700.00
Fee: $20.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Western Mass Siding & Roofing 105630
Lot Size(sq. ft.): 8015.04 Owner: OQUENDO-TIRADO VANESSA
Zoning: URA Applicant: Western Mass Siding & Roofing
AT: 7 BERNACHE ST
Applicant Address: Phone: Insurance:
63 East Street (413) 586-5227
EASTHAMPTON 01027 ISSUED ON:01/04/1999
TO PERFORM THE FOLLOWING WORK:INSTALL VINYL SIDING
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: e, (
�I-
THIS PERMIT MAY BE REVOKED BY THE CITY e F NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupanc -G' ----drr Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 01/04/1999 $20.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo