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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS.
ZZs 19-� Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location �� S/ 14oe-),sZj7f4-7/'jei,-1-- !', ' Lot No.
2. Owners name 6t�lxt-l/m Address
3. Builder's name S�f �'/ � °�rlwl r�P�t j<L Tdr't Address 17 i of I - 5� r,+lf1J,�Gl
Mass.Construction Supervisor's License No. /) 3 Expiration Date � / �/
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 VZ nn
U 0&
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are we to the best of his.
knowledge and belief.
gnature of responsible app.icant
Remarks i� >' �a/ Z 2 L k Kv ,r l kl er
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m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass.• 01060
WORICER'S CO'N1TENSATION INSURANCE AFMAVIT
with a principal place of business/residence at:
/ 7 Lq1J6G5 S JfS7h-�9 7 f727Ai 602 7 (phone#) 29 el7d
(street city/stalcJrip)
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 dm 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 Comparry/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance CompanyRoLicy Number) (Expiration Due)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date)
(anadi ad&ticc l sled ifneocssary to bdudc infocmatioa pertainiag to all matadmss)
I and a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aw=that v4@o homcowvas wbo employ peaom to do=aid�c=bvctioo•ar ripair warn on a dwelling of
not moon than throe vans is which the bomwwoer resides or oa tb a grounds Vouteaunt tbado are oa twerally oomidcmd to be
aaptoyers under the work=1%oompeasdicn Ad(GL 152,ss 1(5)1 application by a homeowncf for a Gomx a puma may evid-ec the
legal lotus of as employee under the Workees Cociv matioa Ad
I understand that a evy of this statemcot may be fawardad to the Depu mm2 of lad,rstrial Accidm&Oboe of 1=wA%D a for d"
covaage vaifieatioa and that failure to sown oovaxp under soctioa 25A of MOL 152 can lad to the impasidoa of criminal Penalties
coaustmg of a•file 70fup to S1,500.00 andlor imprisoaneat of tip toe=year sad civil paariia is the form of a Stop Warlc Order and:
fm of 5100.00 a day ags3asi ma
For dcpatma blU-only
. Pet;mitNtltaber
--------
tgn�ahtte
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 eolmm to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L• R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
Lot az-ea minus bldg
&paved parkingi
# of -Parking spaces
f of Loading Docks
Fill:
4vo1-ume-& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge
DATE: 2. C APPLICANT's SIGNATURE —Lr�
NOTE: lasu noe of zoning permit does not relieve an appiioanjKs burden to oomply wltb .all
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission, Department of Publio Works and other applicable permit granting authorities.
FILE #
DEC
2 71999 r
File No.go DEPT����
T p
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: ofilus&'/xa
Address: j"7 2. 1V 16 6s 5/r, t"t51 t�IM f X�KTelephone:
2. Owner of Property: _�� ��LC-C� s'/ �'� wj-ik' /ky C a
Address:_ l' Ld l i 62E-&rxjlt- Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): q-xf(" CUry 1-ti -M&
4. Job Location: r (r/I `/ !l�('C/
Parcel Id: Zoning Map# 3,-- Parcel# District(s): s ._''
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
S. Existing se of Structure/Pro e
9 P dY_-- �r
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 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)
I1 VALLEY,ST BP-2000-0623
GIs#: COMMONWEALTH OF MASSACHUSETTS
("'NM.Block: 32C-303 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:roofing BUILDING PERMIT
Permit# BP-2000-0623
Proiect# JS-2000-1112
Est.Cost:$804.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Gropp DE Sheppard Roofing 066306
Lot Size(sg.ft.): 6098.40 Owner: BRENNON EUGENE E&GLORIA J
Zoning.URC Applicant: DE Sheppard Roofing
AT: 11 VALLEY ST
Applicant Address: Phone: Insurance:
17 1/2 Briggs (413) 529-0170
EASTHAMPTON 01027 ISSUED ON 12130199 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMOVE 2 LAYERS & INSTALL RUBBER ROOF
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
nspector 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:
3uilding 12/30/99 0:00:00 1662 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-.1272
Building Commissioner-Anthony Patillo