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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. p{� Alterations
NORTHAMPTON, MASS.
a 19 "1 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location y Lot No.
2. Owner's name Address !z C::n .
3. Builder's name /U'. .e• , Address V ti ..-�1� �•
Mass.Construction Supervisor's License No. dly eo Expiration Date v2y m
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
13. Siding house
14. Estimated cosL-
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
,GCS'• u• � .
Signature of responsible app,ican1
Remarks
M
a � MAR 2 2199a C�ix�r oaf ��#l�ttnt�rt�n -
S*1X
s �lassacgasctts
FfrT OF flllr DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFMAVIT
ci per[ni«.ee)
with a principal place of busiinnes�sy/,resi!de_nce at:
TiV- .� ..�
(st=UCity/SWd2ip)
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 Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Inarraacc Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attadt additi shot ifnooeaary to include informirion pertaining to an coatraa s)
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 while h0moaw=3 who employ peaons to do maabmaace,construction or repair work on a dwelling of
not more than throe units is which the homeowner resides or on the grounds appurtenant tba do are not gcocrally oonsidered to be
eruployen under tbo worker's compensation Act(GL152,ss 1(5))�application by a homeowner for a license or permit may evidence tho
legs!ctabsa of an employer under the Workeet Compensation Act
I understand that a copy of this statement maybe forwarded to the Depwtm=d of Industrial Ao64=b'l oo of Insurance for the
coverage verification and that failure to aeatre coverage under section 25A of MOL 152 can lad to tbo imposition of criminal peaaltiea
eoniut mg of a fine of up to S 1,500.00 and/or knpr6ormxat of tip to one year and awl pmaltia in the form of a Stop Work Order and a :1
firm 0(3100.00 a day against me.'
For departmental use only
�f', Permit Number
• fig els.Li Gs�' �, o`Z } Map# Lot# --
x Signature of Licensee/Permitiee Date
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 column to be filled in
by the Building Department
Required
Existing Proposed By Zoning
I Lot size
Frontage
Setbacks - frnnt
- 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
�r is true and accurate to the best of my knowledge.
DATE: ial t �9' APPLICANT's SIGNATURE
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to oomply with 4111
zoning requlrements and obtain all required permits from the Board of Health. Conservation
Commisslon. Department of Publio Works and other applicable permit granting authorition.
FILE #
t
t '
qb
!3 ri ►
File No N, /Gy
DEPT of SUH q4G 1MSPECTl4t3"
PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: "S Gc.
Address: 7� lly alz�' —15�— Telephone:
2. Owner of Property: Q Ll &A
Address: y Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: _
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUI DING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupabon: (Use additional sheets if necessary):
Al
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.
S. Has a Special Permit/Vadance/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)
File#BP-1999-0778
APPLICANT/CONTACT PERSON DA Williams
ADDRESS/PHONE 81 Water St. (413)586-3139
PROPERTY LOCATION 4 CROSBY ST
MAP 25A PARCEL 048 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled o%
Fee Paid `'eflY $� O
T_ypeof Construction: REPLACE TUB&WALL
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 014612
3 sets of Plans/Plot Plan
THE 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 bin Conservation Commission
23
Signature o ui ing ial 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.
A I ~
4 CROSBY ST BP-1999-0778
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25A-048 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category Non structural interior renovations BUILDING PERMIT
Permit# BP-1999-0778
Project# JS-1998-0049
Est. Cost:$1000.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: DA Williams 014612
Lot Size(sa.ft.): 15158.88 Owner: KELLY JOHN R&DOROTHY J
Zoning:URB Applicant: DA Williams
AT: 4 CROSBY ST
Applicant Address: Phone: Insurance:
81 Water St (413) 586-3139
LEEDS 01053 ISSUED ON:3123/1999 mom
TO PERFORM THE FOLLOWING WORK:REPLACE TUB & WALL
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 Silinature•
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 3/23/1999 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo