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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER
Repair
Garage
1. Location f` ► I t G�G e��rorc Lot No. n
2. Owner's name MQ111 ' Address L't r tom_
3. Builder's name 1V K7 Address � r��' A.
Mass.Construction Supervisor's License No. _3&�)'—Expiration Date 34P3
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 housesi
14. Estimated cost-
The undersigned certifies that the above statements are we to the best of r.
knowledge and belief.
Oignaiure of responsible app,ican,
Remarks ti' Jl �� 3/t1 4 C✓' ��')��� IbL41, Lcp S,C/-::�
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zfl EPAFTMENT OF BUILDrNG INSPECTIONS
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p_FT Of 84l 27,2.Main Street ' Municipal Building
Northampton, Mass. 01060 y
WORKER'S COMPENSATION INSURANCE A t t AVTT
(liceuserJpermittee)
with a principal place of business/residence at:
�c)k /I A---(phone#)
(&U=Ucity/statthip)
do hereby certify, under the pains and penalties of perjury, that:
O I am an employer providing the following worker's compensation coverage for my
employees worlang 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) (In-nirancc Company/Policy Number) (Expiration Date)
(Name of Contractor) (lnsumcz- Company/PoLicy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Date)
(attach additional shirt ifnaeuvuy to inehsde infbrm oa pataiaing to ell oor�racion)
(5�} 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 whilo homcoµvcrs who amploy perzam to do my imm•=cosastucdoa or repair work on a dwcUing of
not mote than throe units is which the homoowncr resides or ca the grmwds appurtea therdo arc not gcaa alley ooarid«cd to be
employers under the worker`s oompcasation Act(GL152,ss 1(5)),application by a homeowvcs for a liccose or permit tnay evidence the
legal daw of an employer under the Workoes Compomaiion Act
I undasfand that a copy of this datemccd may be forwerdod to the Dtpartmcn of I.&=trW Apeidca&Offioe of ln=Aruwa for the
coverage verification and that failure to team covango tinder section 25A of MGL 152 can lead to tha impos—of criminal Penalties
oomistiag of a fine of up to S 1,500.00 andfor imptisoamc�of up to one y=and civil
pcaa2tia in the form of a Stop Work Order and a
fine o(5100.00 a day against tnc.
For dgrat=0W uao only
permit Number
�3 �y Wit#
signature of Li ermittee Laice
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 COMPLE'T'ED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This coluffi 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
&p_aved parking)
# of Parking spaces
ht 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: `�g APPLICANT's SIGNATURE
NOTE: Issuance elf a zoning permit does not relieve an applioant' urden to oomply with all
zoning requirements and obtain all required permits from the 13 of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
7.
Z 4 6%
' t 9 7�'
OF '3 File No
rT __ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: �a�+( AJ&^-ta.
Address: c? V44 s+ 14 Telephone: Z --w9 j
2. Owner of Property: 4a=±:
Address:&b �bc�., �t 4!,b2,L A Telephone: aj"3 ---,)c)34
3. Status of Applicant: Owner ✓ _Contract Purchaser Lessee
Other(explain)M: j
4. Job Location: 15- i `Ilch Mrs
Parcel Id: Zoning Map#5,, Parcel# District(s):
(TO BE FILLED IN BY THE BUILD NG DEPARTMENT)
5. Existing Use of Structure/Property (P
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
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/Variance/Finding ever been issued for/on the site?
NO DON'T KNQ:A.1 `� 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)
3
11 MICHELMAN AVE BP-1999-0784
GIS#: COMMONWEALTH OF MASSACHUSETTS
MV.Block: 32C- 147 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:vinyl siding BUILDING PERMIT
Permit# BP-1999-0784
Project# JS-1999-1411
Est.Cost: $10000.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: DAVID NUNEZ 128305
Lot Size(sq ft.): 5227.20 Owner: HART JOAN M
Zoninp-:URC APP licant• DAVID NUNEZ
AT: 11 MICHELMAN AVE
Applicant Address: Phone: Insurance:
67 YALE ST (413) 536-7191
HOLYOKE 01040-5655 ISSUED ON:312411999 0:00:00
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:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupy Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 3/24/1999 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo