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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
%r NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
r Garage
1. Location i'"�S Lot No.
2. Owner's name 11 a.. • . • ,A A • Address 319 +
3. Builder's name lA+ `T 1�L �,l Address Pb J'OX �� s,�„r-ci..',.. a 4 / ?p 3
Mass.Construction Supervisor's License No. //(i.S t)17 LI 4 O y Expiration Date 7///2 co
4. Addition
5. Alteration h\-<_.- , n r b- f. c-.- S Q4-ti
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
14. Estimated cost:- f 12 t , a-••
The undersigned certifies that the above statements are true to the best of his,
kn•wled:e and belief.
if MA
Signature of •. sible app'icant
Remarks g n 5)-,i)i.,i n z-,.✓ 0✓lti.,/1, \''' 'C',” AA d I 'f t o`11 ez.! 01-64.K <. 4..c.c_
0 n� ,\ � 1 a n a, 1 V�tom ) -t D V- v x 14-
. , ..
. .
[.....' i. AUG I 8 1999
.: „ . :
Restricted '0: 0
iV - cf e.lclose6 space
.M3,. r...11: S.9li
IA - Masolri onif
li - 1 i 2 Family Nome::
Failure to possess a current edition of the
Massachusetts State Building Code
is cause for revocation of this iicense
,--1-71e (o fir J)16 ieweeddr (1
1
DEPARTMENT OF PUBLIC SAFETY
44,
CONSTRUCTION SUPERVISOR LICENSE
Number: Expires: BirthCate:
CS 964494 91/91/2999 97/01_1919
Restricted To: 90
i,
,; Ub,„,,,r 0.844,r NATTHEW 3 DERV
i PO BOX 43
S DEERFIE10, AA i1373
!t`wt )��lfl LLZ LXZ a11T�i IITt a --*_,,
a ��+�► ���B tsaarlinsetts ='� =
'1� � 1 81999 =_�t__=
.� ' DEPARTMENT OF BUILDING INSPECTIONS =_`i
•. 212 Main gtreet • Municipal Building
`°"" "°"' -- ---.- .• t rthimpton, Mass. 01060 •'�.�
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, 'J r }E w \ . El=y
N se /lermittee)
with a principal place of business/residence at:
b 01( qX S M A- be3 �_.? (phone#) 29/3165' J/J/-
(street/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:
(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 Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach ..cal shod ifnocessary to include information pertaining to all oo tractors)
( 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 persons to do ma mt i ,constructi Oa cr ripaa work on a dwelling of
not more than three units in which the homeowner resides or on the grounds appurtenant thacto are cot generally considered to be
employers under the worker's oompcasation Ad(GL152,ss 1(5)),application by a homeowner for a license or permit may evidence the
legal status of an employer under the Worker's Compemaiioa Ad.
I understand that a copy of this statement may be forwarded to the Department of Industrial Accidents'Offioo of Iawn000 for the
coverage verification and that failure to secure mvcrago under section 25A of MOL 152 can lead to the imposition of criminal penalties
coosisiing of a foae of up to 31,500.00 and/or ap isorm cct of up to one year and civil peoaltics in the form of a Stop Work Order and a .
fine 01'3100.00 a day against me.
• For departmental sane only .
/ Permit Number
t gip# Lot it
Si ofLi.- •ermittce
10. Do any signs exist on the property? YES NO
NO
IF YES,describe size,type and location: � h a,,,,S fl 01)A. ,n5
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 coin 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: I
�l �9 APPLICANT'S SIGNATURE
NOTE: Issuanoe 6t a zoning permit does not relieve an a plioanr burden to m ly With all
zoning requirements and obtain all required permits from the Board of Health, onservetion
Commission, Department of Publio Works and other applicable permit granting authorities.
FILE #
T, i +I ?_ 1r i f
f C; i1 i a !1
s '
i, AUG I 8 19 9 0()/ /
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: A61,A-V 1),___-,
p L � �
Address: 1 AT®x 13 4,�r 1)a , Wi A- D 13 7-3 Telephone: L//.3 4 5 S / 3 6
2. Owner of Property: ?d \O\ 70 si,A p.3 o n
Address: 3 4 .5A,. 1 4-11 5 4 . Telephone: 4 13 fKI 35-3,-
3. Status of Applicant: X Owner Contract Purchaser Lessee
Other(explain): C✓/Jh`a. ?'o
4. Job Location: 3 L 5 w. , V ,
�
Parcel Id: Zoning Map# X302'—/l Parcel# / r District(s): --
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property ?)..r41,- t.,5 u dA ID\C I< SM A � �op
6. D.e1 �cription of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
Nt .,j 6L"` " . PeA--c.(---
Ce 1.06.-N ....—A c\ \\ti...))kIty
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 X 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)
File#BP-2000-0181
APPLICANT/CONTACT PERSON MATTHEW DERY
ADDRESS/PHONE P 0 BOX 43 (413)665-5136
PROPERTY LOCATION 36 SMITH ST-RALPH'S BLACKSMITH
MAP 32C PARCEL 108 ZONE SI
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildinl Permit Filled out
. �, �� A. L
Fee Paid ,n2 C0/3 i' 7 ) o• fr,
Typeof Construction: CONSTRUCT NEW WALLS FOR ADDITIONAL OFFICE SPACE&ADDITIONAL
HALL FOR EXIT
New Construction
Non Structural interior renovations ■
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 064404
3 sets of Plans/Plot Plan
THE FfdLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
pproved 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 Co •/.'on
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.
36 SMITH ST-RALPH'S BLACKSMITH BP-2000-01 81
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:32C- 108 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:renovation BUILDING PERMIT
Permit# BP-2000-0181
Project# ,1S-1999-0960
Est.Cost:$12000.00
Fee: $170.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: MATTHEW DERY 064404
Lot Size(sq.ft.): 14374.80 Owner: Orchard Electric
Zoning: SI Applicant. MATTHEW DERY
AT: 36 SMITH ST - RALPH'S BLACKSMITH
Applicant Address: Phone: Insurance:
P O BOX 43 (413) 665-5136
SO DEERFIELD 01373 ISSUED ON:8/23/1999 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT NEW WALLS FOR ADDITIONAL OFFICE
SPACE & ADDITIONAL HALL FOR EXIT
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:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy $isnature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 8/23/1999 0:00:00 $170.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo