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36-011 (3) O � tv O m e k Z m r A O Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MASS. -JK L`l 6: 19= Additions a APPLICATION FOR PERMIT TO ALTER Repair Garage 1. Location 1:�,a U +�A2 �� w u-✓1 bt-, .j x- Lot No. 2. Owner's name �0 o-&X r Address ;;Ii, 3. Builder's name r r��� �� T t Address "i 1 K ev�el S� . le[A--c,,.,.00 � Mass.Construction Supervisor's License No. Expiration Date 4. Addition r 5. Alteration 6. New Porch 7. Is existing building to be demolished? C1 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- S7 000 The undersigned certifies that the above statements are true to the best of his, her knowledge and 0aief. Sig nab4,elrespons ible app'14W, Remarks JUL 71999 �=statEanettle DEPtL�tTMENT OF BUILDING INSPECTIONS . n 210 Main Street ' Municipal Building ' - Northampton, Mass. 0I060 WORKER'S COMPENSATION INSURANCE AFMAVIT I, CSC /L /� �7-��e6S 6'J��fv.•.( � .1`•�Co,�� (li censtrJpe:mitter} with a principal place of business/residence at: Zq( /l1ArCt 5l 4 ,4114 (phoneK) g13 536. (Strt:°.t/clty/ `'Zip) do hereby certify, under the pains and penalties of perjury, that: (Jf I am. an employer providing the following worker's compensation coverage for my employees working on this job: C113t1Z(01.4 ^ RE f(A/V(C Nlyrtolq NWX 4, OCR.jG� 'ZE (Insurance CO=P=Y) (Policy Number) ('rxgiratioa Date) ( i am a sole proprietor, general contra o or homeowner (circle one) and have tired the contractors listed below who have the following worker's compensation policies' CCM1�A,0 t T�'(C 1/' �1CCc`f_�5 -1C438�Zwo�-g AIL 9 - (Name of Contractor) (L surancc Compazy/Poiicy Number) (Expiratioa Date) UJ C5 •3�3"3C> (tai e of Contractor) (Inslrancc Co=a;zy/Policy Number) (Expiration Date) (Name of Contractor) (Insu=(,— Compazy/PaUcy Number) (Expiration Dale) (Name of Contractor) (Insurance Company/Policy Number) (Exni.radon Date) (aaach adcss+ Coal:boa if necessary to in iafocros on peraLiaiag to all oatauon) O I am a sole proprietor and have no one working for me. O I am a home owner performing all the work myself. NOTE:please be aware ths:while boa= om wt,»alloy P=m w do=&;=t�wmxtr�on cr r"ir war',on a 4--diag of trot mom than three=Vs m w@ic h the bemwwaa r=da cc oe the g=ams rrpurteraci thw':40 are oce gmeralty ooasuiered to be =ploy=under the woricee%oo ,rr�ca Act(GLI52,a 1(5)),appl',m6on by a he c=wx fer a liceme ct peraG may e�^dcxY tFx legal states Of=eaaployer under tho W"kees C4cVemat.ioa AcL I uadavAmd thst a copy of this etstem:z=y be fw varded to the lop utmmt of Industrial Aoci OSoe of Irsusooe for tbs coverage vaifscxiioC end that failure to teaue oovemp under saedoa 25A of MOL 132 can lead to the iespasitioa of aitaiaal peaA!ft co=its:g of a fore of up to 51,300.00 muNce of up to om year and civil penalties is 6e form of a Stop Work Orda sad a , firm of 5100.00 a dty tgaimt ma For&W=='1 use only Permit Number Lot# — Late Signature of Li c ttx ��������►� CERTIFICATE OF LIABILITY( INSURANCE DATE 03/04198`"-/98 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Insurance Professionals of NE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 19 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE Sturbridge MA 01566 COMPANY A CyberComp/Relianoe Nation NSUFED COMPANY Barron & Jacobs Associates 241 King Street 7 COMPANY Northampton MA 01060 COMPANY D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED EELO'N HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 100ATED, NOTWITHSTANDING ANY REQUIREMENT, TERM CR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN (S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION :LCTOR TYPE OF INSURANCE POLICY NUMBER DATE (MMJ00jYY) DATE (MMICOrYY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE s COMMERCIAL GENERAL LIABILITY PRODUCTS•COMP OP AGG s CLAIMS MADE 7 OCCUR PERSONAL d ADV INJURY s OWNER'S&CCNTRACTOR'S PROT JEACH OCCURRENCE s FIRE DAMAGE (Any one fire) s MED EXP(Any one Person) $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s ANY AUTO ALL OWNED AUTOS 90D1LY INJURY SCHEDULED AUTOS Per person) s HIRED AUTOS BODILY INJURY s NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE s GARAGE LIA31UTY AUTO ONLY• EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY. S s EXCESS LIABILITY EACH OCCURRENCE s P UMSFELLA FORM AGGREGATE s OTHER THAN UMSRELLA Fv^RM s WORKERS COMPENSATION AND X T04Y�L, E� EMPLOYERS'LIABILTY A NAX6003626 03/01/98 U1101/99 S.EACH ACCIDENT s 104,000 THE PROPAIETORi X INCL EL DISEASE'•POLICY LIMIT s 600,000 , PARTNERS�`XECUTIVE CFF!CERS ARE: I EXCL EL DISEASE •EA EMPLOYEE s 100 C00 OTHER I I. I DESCAIPTON OF OPERATIC NS,LOCATIONS VE HICLE$,SPEC�AL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLIDES BE CANCELLED BEFORE THE EXPiFATICN DATE THEPEOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WAITTEN NOTICE TO THE CERTIFICATE HOLDER,NAMED TO THE LEFT, BUT FAILURE TO MA,L SUCH NOTICE SHA'L IMPOSE 0 OBLIGATION OR LIASILIT Y OF ANY KIND UPON THE COMPANY, ITS A "NTS EPRESENT IVES, AUTHORIZED REPRE ESqMTWE William J, Szaf )6�,ty ACORD 25-S (1,15) ©�'�ACi0 CORPO TI 1988 �n J J Q 7 L v�C� 'X Z LL] Lu 011 : W O U W ............................ ..: a � cry W w a i S © I I z C) i O I-- � CL CE <Q I Q p CL Q J Z ©_ Z J U cra C� � = O � m �D a F In I— Z W J N rY O O n W Q(10 _jU Ifl 10. Do any signs exist on the property? YES NO IF YES,describe size,type and location: Are there an proposed changes to or additions of signs intended for the property?YES NO YP P IF YES,describe size,type and location: Z1. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE To LACK OF INFORMATION. This cola to be filled in by the BmIldiny Depar=wnt 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 &p?Ved parking) # of -Parking Spaces # 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: APPLICANT's SIGNATURE NOTE: lssuanoe of a zoning permit does not relieve an applioant's burden to oomph► Wp4 .Mall zoning requirements and obtain all required permits from the Board of Health. Conaervestion Commission. Department of Publio Works and other applicable permit granting authorities. FILE if JUL 7 j9gq Fi 1 e No. �� a b ZONING PERMIT APPLICATION (§10 . 2) - � PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: z a f r ati C' C,o b S Address: `2 14 I ��✓�c. ST Telephone: 5S(_.9 9 16f A 2. Owner of Property: Address: G I x.n Telephone: �; , 1' 11 14' 3. Status of Applicant: Owner Contract Purchaser Lessee ✓ Other(explain): L-Le 63 C la 1/\ r 4. Job Location: ':� > r–u r e�(-,,�,' (Az � �+�laj Parcel Id: Zoning Map# J `� Parcel# District(s): _,.624 (TO BE FILLED IN BY THEyBU LDING DEPARTMENT) 5. Existing Use of Structure/Property '`�S k -►✓� 'l cA 6. Description of P oposed U�JeMork/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 10 DON'T KNO�ti' 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—L/_ 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-2000-0024 APPLICANT/CONTACT PERSON Barron&Jacobs ADDRESS/PHONE 241 King St (413)586-8998 PROPERTY LOCATION 58 FOREST GLEN DR MAP 36 PARCEL 011 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: t PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: REMODEL KITCHEN&DINING AREA New Construction Non Structural interior renovations Addition to Existing Accessory Structure - Building Plans Included• Owner/Statement or License 030739 3 sets of Plans/Plot Plan THE F OWING 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 Commi 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. c 58 FOREST GLEN DR BP-2000-0024 G1S#: COMMONWEALTH OF MASSACHUSETTS Map:Block:-36-011 CITY OF NORTHAMPTON Lot: -001 Permit: Building Categ_ory:renovation BUILDING PERMIT Permit# BP-2000-0024 P_roiect# JS-2000-0033 Est. Cost: $39000.00 Fee:$195.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Barron & Jacobs 030739 Lot Size(s9.ft.): 14766.84 Owner: BOMBARD RAYMOND A&JANET R Zoning:URA Applicant, Barron & Jacobs A_T: 58 FOREST GLE-ND R Applicant Address: Phone: Insurance: 241 King St (413) 586-8998 Workers Compensation NORTHAMPTON 01060 ISSUED ON.7112/1999 mom TO PERFORM THE FOLLOWING WORK.-REMODEL KITCHEN & DINING AREA 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 Sip-nature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 7/12/1999 0:00:00 $195.00 1 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo