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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. /Z'/ X7 19 Additions
a APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location 47�' f/' f 4rillr:-/r,/ /0/-1 1-42/21r Lot No.
2. Owner s name �T 1� /!�i✓ S< �� Address ��' C��s�lei�'u� CZ/v 7 �✓zsr�=
3. Builder's name L,q/�/l Y T yf,v;Tst/�' Address
Mass.Construction Supervisor's License No. J:f 8 6 6 Expiration Date 112Ca y
4. Addition
5. Alteration '57WIP
6. New Porch
7. Is existing building to be demolished? iV�J
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:-
The undersigned certifies that the above statements are true to the best of his.
knowledge and belief.
Signature of responsible app,icant
Remarks
• i6
o�'Ctt/►�t'P�O
� B �lassacansetts
DEPARTMENT OF BUILDITjG INSPECTIONS
212 Main Street a Municipal Building '
Northampton, Mass. 01060
WORKEWS COMPENSATION INSURANCE AFFIDAVIT
L Z,)P—,t7 y 1
(licenseelpermittee)
with a principal place of business/residence at:
J/es-3 (phone#) �r�`1 17��
(streedcity/statelap)
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 worldng 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 Compauy/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additiocal short if nwcauy to include information pataining to eel contractors)
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 v6lo homcom=who employ pasom to do makicamce,comutution or repair work on a dwelling of
not more than throe um ft is vd ich the bomeo%n resides or on the p ma&appeuteaant lborato are not ge»erally o mWtd to be
employ=under tbo wo ice's compere acic a Act(GL152,s 1(5)),application by a homeowner fora Gceate or permit may evidence the
legal status of an employ or underthe Workoes Compeaaation Act
I understand that a copy of this datemmt may be forwarded to the Depubwat ofradaiuial A06&ct a Offioe of Imunnce for the
coverage verification and that failure to secure covaago under section 25A of MOL 152 an lead to tba=posdioa of criminal peasltiea
000sb emg of a fine of up to$1,500.00 and/or kgcbonmart of up to one year and civil penalties in the form of a Stop Work Order gad g
fiao of 5100.00 a day ag6ad m.
For dq»stme�►��Y
Permit Number
Mao _I,&#
Signature ermit:tce Me
=ail
rea:uYriR:.asi-ia�w.
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 col— to be filled in
by the Hnilding Department
Required I
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L• R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
# of Parking Spaces
e 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 knowledge.
DATE: /49 /Zt Z:f ^_ APPLICANT's SIGNATURE
NOTE: Issu no® of a zoning permit does not relieve an applio urden to comply wlt" all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applionble,permit granting authorities.
FILE #
File
ZONING PERMIT APPLICATION (§10 . 2)
pTZ SE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: yr'iyr5G!f .
Address: /// E.2-< Telephone: S!Fr y--175 _
2. Owner of Property: STS�/�✓�<� SLF l�
Address: �� C�� ST Vl�G�� D/L j Ly2-' Telephone: f5,5�y-
3. Status of Applicant: Owner t/ Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# c Parcel# District(s):
(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):
STp)p pIV.,4- A y dL �s - sib<.✓GGSS /? ��/r f Ld' G+'/e�9 iLxG+J�4<La >�l 'cTG2 /tom
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/Vadance/Finding ever been issued for/on the site?
NO DON'T KNOW t/ 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`Z 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)
40 CRESTVIEW DR BP-2000-0470
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29-452 CITY OF NORTHAMPTON
Permit Building
Category:roofing BUILDING PERMIT
Permit# BP-2000-0470
Project# JS-2000-0819
Est, Cost:
Fee: $25.00 PERMISSION IS HEREB Y GRANTED TO:
Const. Class: Contractor: License:
Use Group: Larry Yentsch 048666
Lot Size(sq.ft.): 1 001 8.80 Owner: SLEZEK STEVE&DIANE
Zoning:UP-A AP.P.Rcant: Larry,rr, Y emasc
AT: 40 CRESTVIEW DR _
Applicant Address: Phone: Insurance:
111 WATER ST (413) 584-4750
LEEDS 01053 ISSUED ON:1113199 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP 1 LAYER & SHINGLE ROOF
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:p k l I - 3• q ..��
THIS PERMIT MAY BE REVOKED BY THE CITY OF N R1 WON-UPON VIOLAT , N OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occu anc nature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 11/3/99 0:00:00 $25.00
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo