36-279 (4) 5
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No Alterations
NORTHAMPTON, MASS. 19 Additions
' APPLICATION FOR PERMIT TO ALTER Repair
}}�,, l �} _ Garage
I. Location tat)F`4� A4. P0�i.CX Hoe? V�' ' - Lot No.
2. Owner's name #'4 &r'vS jars Address
3. Builder's name &1 j r e O.A Address
Mass.Construction Supervisor's License No. Expiration Date E?
4. Addition /ylllJlr- 1�47t'� �,r*�rCL' I ®s
5. Alteration
6. New Porch G +Q'4 V-
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 S`-e �D {�1�n,>
12. Type of roof S YV` �i h Q k-<S
13. Siding house
14. Estimated cost:-
/,
The undersigned certifies that the above statcmcnis are we to the best of t
knowledge and belief.
Signature of responsible appicant
Remarks
.:.:.:................................................. .......... ........
... ..... ... .......................................................................................................... .......
iliw AM
06/03/1999
LT
DATE(MIMI)M)
... .... ....
..... ....
FIC
C
ACORP, ........ !E..-*'. ..O.'F.-..-'....--.-"-'....'-'.--: I B11 t
............................................................ .. .. X
.................
............ X-X'��"X.x. . . . ...... . ............ . . . ............. --------------
PRODUCER (413)586-7373 FAX (413)584-0859 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
kquadro & Associates Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
355 Bridge St. , P. 0. Box 357 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Northampton, MA 01061 COMPANIES AFFORDING COVERAGE
.............*......................................................................................................................
COMPANY
Travelers Insurance Company
Attn:
.............C...H...R...I...S.I T...I...N...E......M......S...U...L..L...I...V...A...N..
...... ......................................E...x...t..:
.... . .................A
.........................................................................................................................................
INSURED
COMPANY
Thomas Dawson- Cregn
PoBox 556 ...................................................................................................................................................
Chesterfield, MA 0 COMPANY
QFjgAM���Mpd1060 C
...................................................................................................................................................
COMPANY
....... ........ ...........................
....... ......
..............
................ ....
................................ *.. .......... .......................
POLICY PERIOD
........... . ...... . ....
.... ......... . ..................... .......... ...........I...............
.... : . .... .. .......... . ................... ......... .........
...................
........... ...................................
. ................
.........:". ... .. ............ .. ....
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TH
INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR 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 IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
...........................................................................................................................................................................I....................................................................................................................
Co POLICY EFFECTIVE:POLICY EXPIRATION:
TYPE OF INSURANCE POLICY NUMBER i LIMITS
LTR
DATE(MMIDDIYY) DATE(MWDDrfY)
GENERAL LIABILITY GENERAL AGGREGATE i S
2,000,000
........................................
X PRODUCTS-COMPIOP AGG AL L
COMMERCIAL GENERAL 5 2,000,000
. ........ ...... ............................................................................. ...
$ 1,000,000
CLAIMS MADE X :OCCUR PERSONAL&ADV INJURY
.......... ...... 1-680-394W629-6-COF-99 :: 07/12/1999 : 07/12/2000 ....................................................................................
A
OWNER'S&CONTRACTOR'S PROT: EACH OCCURRENCE
1,000,000
....................................... ........................................
FIRE DAMAGE(Any one
$
300,000
:. ..... .........
..
......... .............................................. . . . ....
MED EXP(Any one person) $ 5,000
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO
.......................................................................................
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) $
.......................I.............................................................
HIRED AUTOS
BODILY INJURY
(Per accident)
NON-OWNED AUTOS
.....................................................................................
PROPERTY DAMAGE $
. .. . . .......................
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT
...................................... :X.
'**.........
........... .
............. .....
ANY AUTO OTHER THAN AUTO ONLY ............
.........
.........
............
....................I............................I....... ...........
.......... ..... .
EACH ACCIDENT:$
.....................................................................................
....
AGGREGATE::$
EXCESS LIABILITY
EACH OCCURRENCE . .....................................
. ....................__....................
UMBRELLA FORM :AGGREGATE
.....................................................................................
OTHER THAN UMBRELLA FORM $
.. . .......
.. ....... ...
. . .. ... ....... ...
WORKERS COMPENSATION AND ..... ..
EMPLOYERS LIABILITY
EL EACH ACCIDENT $
..................................
...... .......
THE PROPRIETOR/
INCL EL DISEASE-POLICY LIMIT .$
PARTNERSIEXECUTIVE
................**"**.................................................
OFFICERS ARE: EXCL: EL DISEASE-EA EMPLOYEE:$
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS
...... ............ ..... .. .. ......
................. .. .. .... ..
. ..... ........ ......C
............%.......
............
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
MONICA CRIESDORN & ROBERT SANQUILY BUT FAILURE TO MAIL SUCH NOTICE SH L IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE C A ENTS Oq REPRESEnATWES.
881 BURTS PIT RD z
FLORENCE, MA 01062 AUTHORIZED REPRESENTATIVE
CHRISTINE M SULLIVAN
.... .. ....
....................
P" >:<......: . . ..... . ... .......
• ' . cry
$ � 9 � �laesxchusctts
e
Grit� of 'Nart4aillptan JD
101 tNgPEQ5014)E TMENT OF BUILDING INSPECTIONS _
� M1r(C1h fm 0106
INSPECTO WORTH 212 Main Street • Municipal Building o,4
Northampton, MA 01060
Applicant Information
Name_--
Location i — -- ------------
1 t
City _C �► --� -- ------
[am a homeowner performing all work myself
W I am a sole proprietor and have no one working in any capacity
P
❑ I am an employer providing workers' compensation for my employees working on this job,
Company Name___ — ------ --
Address
City-- --- ---------- Phone#--------
Insurance Co._ _----_-----__—Policy#------ --_
Company Name :�77—hb,07 /9 $ I°}6(/s4:0j
Address �'" ''
4V 1 �Y t 0
City " : Phone #—///. ._.
Insurance Co. Policy# T"'9 ` '"
Failure to secure coverage as required under Section 25 A of MGL 152 can lead to the imposition of criminal
penalties of a fine up to$1500.00andtor one years'imprisonment as well as civil penalties in the form of a STOP
WORK ORDER and a fine of$100.00 a day against me. 1 understand that a copy of this statement may be
forwarded to the Office of Investigations of the DlAfor coverage verification.
I do hereby certify u der the pairs and pes of perjury th he information provided above)s true and correct.
r
Signature
Print Name_A� x ? i.�� f/b Phone x
Official Use Onty, Do not write in this area to be completed by city or town official
City or Town PermiVLicense;r ❑ BuUncDept
❑Li=euint Bond
Check if immediate response is required
Q Sekctnea'Dept.
Contact Person Phone
Q Hea]tlt Dept.
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"K0'HA"-ORN T PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: % h Ohl !9�-..S � 111 �✓--S" OAJ G
Address: X C44?4 P OM#�S Telephone:
2. Owner of Property: tyl Cq 11 r -§4,V # "
Address:a S I I- /, r4"jV40 ,fW Telephone:
3. Status of Applicant: Owner _Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# Parcel# J 7 District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property ,�r 4P o ( ��
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
,Id x a 'o�� 31-1 a.
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 Per i ariance/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 D ument#
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)
I HIS PLAT NOT FOR RECORDING PURPOSES
j
Plan Book 149 Page 69
Lot #24
r , �33,7Y Plan Book 154 Page) 19
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To; The Source One Mortgage Services Corp , b
The First American Title Insurance Co.
1 HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES,AND EASED ON EXISTING MONUMENTATION,ALL EASEMENTS, ENCROACHMENTS
AND BUILDINGS ARE LOCATED ON THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES. 1 FURTHER
REPORT THAT THE PROPERTY IS NOT LOCATED IN A FLOOD PRONE AREA AS SHOWN ON FEDERAL INSURANCE MAPS FOR COMMUNITY
NUMBER.. 250161# .
DATED: September 8 , 1994 NOTE
THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY AND DOES
SURVEYOR' NOT CONSTITUTE A PROPERTY SURVEY.
MORTGAGE LOAN INSPECTION PLAT
µft{ OF Northampton, Massachusetts
RICHARD Prepared For
J. Gregory Giambalvo
BARGE SR. -t
134605 i7 Scale : 1 ��=1 0 lJ '
Richard J. UkUrge, Sr., Registered PTofessional land Surveyor
110 i0ng Street, Northampton, Massachusetts OiW
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File#BP-1999-1062
APPLICANT/CONTACT PERSON Tom Dawson-Greene
ADDRESS/PHONE 14 Antin Rd (413)296-4421
PROPERTY LOCATION 881 BURTS PIT RD
MAP 36 PARCEL 279 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildina Permit Filled out
Fee Paid
Typeof Construction: ADD 3 X 12 TO EXISTING 12 X 15 PORCH ,
New Construction
Non Structural interior renovations
Addition to Existiniz
Accessory Structure
Building Plans Included:
Owner/Statement or License 013633
3 sets of Plans/Plot Plan
THE F LOWING 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 Conservation Co fission
Signature uilding Micial 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.
I
881 BURTS PIT RD BP-1999-1062
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-279 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:Deck Addition BUILDING PERMIT
Permit# BP-1999-1062
Project# JS-1999-1784
Est.Cost: $7200.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Tom Dawson-Greene 013633
Lot Size(sq.ft.): 93218.40 Owner: GRIESDORN MONICA
Zoning: SR Applicant: Tom Dawson-Greene
AT: 881 BURTS PIT RD
Applicant Address: Phone: Insurance:
14 Antin Rd (413)296-4421
CHESTERFIELD 01012 ISSUED ON.611o/1999 o:oo:oo
TO PERFORM THE FOLLOWING WORK.-ADD 3 X 12 TO EXISTING 12 X 15 PORCH
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 6/10/1999 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
Asot
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881 BURTS PIT RD BP-1999-1062
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:36-279 CITY OF NORTHAMPTON
Lot:-001
Permit: Building ,
Cate&=:Deck Addition BUILDING PERMIT
Permit# BP-1999-1062
Project# JS-1999-1784
Est.Cost:$7200.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO
Const.Class: sts Contractor. License:
Use Groin: e_d/ Tom Dawson-Greene 013633
Lot Size(sq.ft.): 93.218.40 Owner: GRIESDORN MONICA
Zoning:SR Applicant: Tom Dawson-Greene
AT: 881 BURTS PIT RD
Applicant Address: Phone: Insurance:
14 Antin Rd (413)296-4421
CHESTERFIELD 01012 ISSUED ON.•6/lo/1999 o:o m
TO PERFORM THE FOLLOWING WORK.-ADD 3 X 12 TO EXISTING 12 X 15 PORCH
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: 14 p L E S ait
Final: Final:
Rough Frame:B it
Gas Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: `< �C,L
THIS PERMIT MAY BE REVOKED BY THE CITY OF RTI AMPTON UPON VI TION OF
ANY OF ITS RULES AND REGULATWM.
Certificate of Occupancy i nature-
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 6/10/1999 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo