35-286 (11) a
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. :-Z
19 Additions
% Repair
' APPLICATION FOR PERMIT TO ALTER
Garage
1. Location .S V l/-11 fi/ 4A.Ir Lot No.
2. Owner's name i" / /-; io ' '� ow 4 PEN !Ni'yW Address y S YL:A'A y L,a .i:
3. Builder's name 4)v i D �14 : V 4 14 tit ,C4 Address. �j ?' j<: D ..,G. �/,,jI FILM �
Mass.Construction Supervisor's License No.Vic/ 2 W A Expiration Date
4. Addition
5. Alteration 'r--; v 5 S IH K14 S ?�'U Env i
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:-
The undersigned rt es that the aboygstatcmcnts are true to the best of his
knowledge an =be
Signature of rtsponsible app,icanl
Remarks
��HAM PT
AWNS, 9�0 ��oyB of ��z#IJtt111�1�II1i r
gB �lasaschnsrtls
DEPARTMENT OF BUILDDIG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, v J") I(Cl y 41 -!4 (j >- r-�-
(licenseeJpermittec}
with a principal place of bus iness/residence ax:
(strcWci ty/scatel2i p)
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) (Polio Number) (Expiration Date)
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 Nu.mbcr) (Expirntioa 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 additioml sbee tf neccuuy to include mfonniton ptrta; 9no to all 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 wbilo homeowners who employ pusons to do u2sinimin c cousuvction or repair work on a dwelling of
not mote than throe units in which the homeowner resides or on the groutxls appurtenant thacto an not generally ooandcrcd to be
employers under the worictes oompcasation Act(GL152,=1(5)�application by a homeowner for a license or permit may evidenoc the
legal ctatua of an employer under the Workees Compomation pct
I understand dua a copy of this rfatcmcnt may be forwarded to tho Dcpcvtmco of Indrutrid Aocidcats'Offloo of Invxmoco for the
coverage verification and that failure to seatre covamgc under section 23A of MGL 152 can lead to the iwositiou of criminal pcnaltia
of a fine of up to S1,500.00 and/or imptisonnx it of up to ow year and civil pcnaltics in the form of a Stop Work Order and a
film o(5100.00 a day agniosi mo.
For depntntow trap only —
Permit Number
7/ Y d 6 v v Map# Lot#
Si of Li ermitfee Date
. .
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CL
rb
lZr
'0000",O/l
10. Do any signs ebst 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 cc'== to be fillad in
by the Banding Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks -- fmnt
- 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 knowled
D21TE: ;7, APPLICANT'S SIGNATURE
NOTE: lasuaAce of a zoning permit does not relieve an applioan b rden to oomply witt all
zoning requirements and obtain all required permits from the Bo of Health, Conservation
Commission, Department of Publio Works and other applionble per it granting authorities.
FILE #
M
Fi 1 e No. �C
t 1 "tt I.y�YJ
uu
V±11 1-1,
° �NING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 11,44_+4`ji-4
Address: c; '--' {� '� u-Y t� !a��TrlL�) Telephone:
2. Owner of Property: +^-; K-t C lr-s 0--V �f vie L�/v ? c N
Address: 9 y S f L V r 4 !)i"�r- Telephone:
3. Status of Applicant: Owner /---C/ontract Purchaser Lessee
Other(explain):? -
4. Job Location: J
Parcel Id: Zoning Map# -35- Parcel# ;?I?'(,, District(s): S�
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property .S!v (,- L € l�91A4 )t Y
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
U -57 J:j E 1t 'T e Vr' of i 1/] 1-t:. S
r
4 CL ! -!E L' .T 5 v `C E rz ICJ
r
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 PermitA/adance/Finding ever been issued for/on the site?
NO DON'T KNOW f � 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-2000-0703
APPLICANT/CONTACT PERSON David Vachula
ADDRESS/PHONE P O Box 112 (413)247-9459
PROPERTY LOCATION 34 SYLVAN LN
MAP 35 PARCEL 286 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: PARTIAL FINISH BASEMENT FOR PLAYROOM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 049846
3 sets of Plans/Plot Plan
THE OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved 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 Consery n Commission
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.
34 SYLVAN LN BP-2000-0703
GIS#: COMMONWEALTH OF MASSACHUSETTS
.4ap:Block: 35 -286 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-2000-0703
Project# JS-2000-1304
Est.Cost: $10000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: David Vachula 049846
Lot Size(sq. ft.): 52576.92 Owner: PETERSON BILL&LAUREN DUNCAN
zonin : SR Applicant: David Vachula
AT. 34 SYLVAN LN
Applicant Address: Phone: Insurance:
P O Box 112 (413) 247-9459
N HATFIELDMA01 066-0112 ISSUED ON:2110100 0:00:00
TO PERFORM THE FOLLOWING WORK.PARTIAL FINISH BASEMENT FOR PLAYROOM
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 signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 2/10/00 0:00:00 2319 $50.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Building Commissioner-Anthony Patillo
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34 SYLVAN LN BP-2000-0703
CIS# COMMONWEALTH OF MASSACHUSETTS
Map:Block:35-286 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:Nox} Wtl W interior renovations ]BUILDING P
Permit# BP-20Q0-11"703
Project# JS-2000-1304
F str C2st'S 10400.00
,. 0.00 PERMISSION IS HEREBY GRANTED TO.
ot.Class: vnt�ractor: License:
Use Group: David Vachula 049846
Lol Size(sq. ft.): 52576.92 Owner: PETERSON BILL&LAUREN DUNCAN
- .-tYi_tt y ��. - - --
AT 4 SYLIT& LN -
.4 ant Address: Phone: Insurance:
P O$ox 112 (413)247-9459
N HATFIELDMA0 1 066-0112,ISS x`.13 UN:2110100 0:00:40
TO PERFORM THE FOLLOWING WORK.-PARTIAL FINISH BASEMENT FOR PLAYROOM
POST THIS C O IT IS VI FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.F.W. Inspector of Buildings
Underground: Service: Meter:
f Footings:
Rough: Rough: z,1. 14a 44x" House# Foundation.:.
Final: Final: ;/_ -P A915P.
Rough Fr 7/w s,S
Gas Fife RM tment Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Simon>cg? Final: 0 kc
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY'OF ITS RULES AND REGULATIONS. �5.
or
e ificat of Oc u n t re:
Fee Type: ec! t No: Date Paid: Check No: 47 Amount:
Building 2/10/00 0:00:00 2319 $50.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Pntillo