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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
a NORTHAMPTON, MASS. Iq Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location Lot No.
U _(
2. Owners name ry"4 rite o coi./ Address A&j P
3. Builder's name A4 1L tai uwslk i Address 37 .56,ee & BAr f
Mass.Construction Supervisor's License No. G s D�y/92 Expiration Date eaa
4. Addition /Qj
5. Alteration -i- F4,,-j -0 k e-"24
6. New Porch
7. Is existing building to be demolished? Al d
8. Repair after the fire l Q
9. Garage Al d No.of cars Size
10. Method of heating t9`-?/•S
11. Distance to lot lines /�'
12. Type of roof 414
13. Siding house A114
14. Estimated cost:-
The undersigned certifies that the above statements are we to the best of his.
knowledge and belief.
sgnatu of responsible app icant
Remarks
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9 DEPARTMENT OF BUILDMG INSPECTIONS
212 Main Street ' Municipal Building
'e
Northampton, Mass. 01060 '
WORKER'S COMPENSATION INSURANCE Arl MAVIT
1, W ��� ► � � \C�tow Sly 1
(liceaserJpermi��ee)
with a principal place of business/residence at:
3 ? S �eRe t Gac ke`t - VV44 o a SL 3 (phone#) , - 0,39-f
(streei/city/state/7ip)
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 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 Compat y/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compaay/PoLicy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(atiaeh addition►sheet ifnoo=uxy to include infotmatioo pertaining to till ooh actors}
(U41I am a sole proprietor and have no one working for me.
( } I am a home owner performing all the work myself.
NOTE:please be award th:t wbilo homcowvcn who anploy persons to do r kztw a c c=Ttuctioo or repair work on a dwelling of
not man thaw throe units is vduch the bomoow=r=Aca or ao the g v=6 appurteauA thereto art not gencsally cou idcrcd to be
employers under the wockees oomp=s4on Act(GL152,=s 1(5)),application by a homeow=for a 6ocn3o cc permit may evidence the
lesil datus of an employer under the Workeeg Compemation Acc
I undcsiaad that a oopy of this ctateascat may be forwarded to tha Dcpwtmrnd of Industrial Aociden&Office of Innursnee for the
covemge vcrificatioo and that failure to secure cov=mV under soctioa 25A of MIL 152 can k2d to the imposidou of criminal pe-Ifics
oomisting of a fmc of tip to S1,500.00 and/or imlxiso�of
lip to one y=and eivt7 prmriies is the form of a Stop or Order and a ,
fmo 0(5100.00 a day against tna
For dqurtaunbI uao oily
Permit Number
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9/V Mao t#
Signature of ermittea
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FIR 1 910 HOME IMPROVEMENT CONTRACTO
Registration 125221 R
4
*.sr
rp TYPe - INDIVIDUAL
Expiration 02123100
WILLIAM J. KOSLOUSKI
���� ��IAM J. KOILOWSKI
R 7_ HORE RD
BECK£T MA 01223
i
fie �oa,�.uueaa/�i a�✓/�/,a�vac/zuaella M
Q4, BOARD OF BUILDING REGULATIONS}
License: CONSTRUCTION SUPERVISOR
Number: CS 064192
Birthdate: 12/11/1956
Expires: 12/11/2000 Tr.no: 5713
0 1
Restricted To: 00 j
WILLIAM J KOZLOWSKI
PO BOX 419
OTIS, WIA 01253 Administrator
:;,; , .,:. .>C, . _,.;.,, >..:�,.n., .v:� >,,, .,..:•,,..<....:.:.. ... .... :•4>:...._ .,.......�,�...... •..a-ax,cn<+cKx)r!eo:>5.....+i>LU+E4u+t...t::a K tiirvt:�t2SStft4Zs{r7 5,t.. ...,
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 MIDST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This colon to be filled im
by the Building Department
Required l
Existing Proposed By Zoning
I Lot size
Frontage
Setbacks - front
- 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
G is true and accurate to the best of my knowledge.
DATE: 9 Ct APPLICANT's SIGNATURE t +
NOTE: lasua oe 6f at zoning permit does not relieve an applioanvs_l3;uKcVq0 to oomply Witfr_all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commisslon, Department of Publio Works and other applioable permit granting authorities.
FILE #
Fobr
FF9 1 91999 q 7/0
File No.
FPT- - ZdNING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant L W r'
� o a
Address: 3 S`• Telephone:
2 Owner of Property: tTuof'v cTt e o'�
Address:— N f Yo v44,eW±N Sf /%te— Telephone: S8'S/- 110,V
3. Status of Applicant: Owner Contract Purchaser Lessee
_Other(explain): o:.v� 1GrerC
4. Job Location: r S• ve'e
Parcel Id: Zoning Map# _ Parcel# - District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property ka:cIote,"&k z
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
QOM e,*,eiC --
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.
6. 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 V""— 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_k___� 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-1999-0710
APPLICANT/CONTACT PERSON WILLIAM KOSLOWSKI
ADDRESS/PHONE P O BOX 419 (413)243-0388
PROPERTY LOCATION 41 SOVEREIGN WAY
MAP 36 PARCEL 297 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: FINISH BASEMENT PLAYROOM BATHROOM,&STORAGE AREA
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 064192
3 sets of Plans/Plot Plan
M THE 'LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presentedibased 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 s on
Signature o 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.
41 SOVEREIGN WAY BP-1999-0710
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-297 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: alteration-addition BUILDING PERMIT
Permit# BP-1999-0710
Project# JS-1999-1312
Est.Cost: $16000.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin WILLIAM KOSLOWSKI 064192
Lot Size(sg.ft.): 32539.32 Owner: JACOBSON JUDY
Zoning: SR Applicant: WILLIAM KOSLOWSKI
AT: 41 SOVEREIGN WAY
Applicant Address: Phone: Insurance:
P O BOX 419 (413) 243-0388
OTIS 01253 ISSUED ON.•2123199 om:oo
TO PERFORM THE FOLLOWING WORK.-FINISH BASEMENT, PLAYROOM, BATHROOM, &
STORAGE 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 Siznature•
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 2/23/99 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo