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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS.—)q J 19 " Additions
- ' Repair
' APPLICATION FOR PERMIT TO ALTER
/ y' Garage
1. Location -V , Lot No/.
2. Owners name ITO #9/"'7'� Address
3. Builder s name
9�- <i��/n�� `YID-t �/�� Address 5i/ Rrin, ! !3✓d/ 'qy '�"U X''�.
Mass.Construction Supervisor's License No. da �yH Expiration Date&"
4. Addition
S. Alteration
6. New Porch
7. is existing building to be demolished?
8. Repair after the fine
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof
13. Siding house y7 :5 Nom/
14. Estimated cosL- !77Jd o�
The undersigned certifies that the above statcments are true to the best of '
knowledge and belief.
signat a of responsible appicant
Remarks
��ttA1Np�
9 6 �lasaucknsctta
DEPARTMENT OF BUILDING INSPECTIONS '
212 Main Street a Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AF)HDAVIT
I, )39'-R Sic,,d q ,1 n3 C-
(li perrnitt�e)
with a principal place of business/residence at:
� t�� *&---7XAm ?a f) PA -7
(phone#) S34-ZI/L
( city/st &:dp)
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:
Ala a C"Isv L/ s C0 os-/s-a o b o
(Insurance Co ) (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) (Insurance Compauy/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date)
(attach additional shed if neoenary to include information pertaining to an ooatraef )
( ) 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 vAWo homeowners who employ pcmm to do maiatenam= cooshucuon or repair work on a dwelling of
not more than throe units in which the homeowner raider or on the groaa&appurtenant th rdo are not generally comidemd to be
employers under the workeez compensation Act(01,152,s 1(5))�,application by a homeowner fora license or permit may evidence the
legal atativo of an employer under the Worlca'a compensation Act.
I undeutaad that a copy of this ctatemeat may be focwe=ded to the DtVwt ccd of rnduitrial Aoddm&Olfioe of Inwraoca for the
coverage verification and that failure to aeuure coverage under section 25A of MGL 152 can lead to the imposition of airmen!Pennliiea
oombdog of a fine of up to$1,500.00 and/or i 4 isomnea of up to one yter aid civil penalties in the form of a Stop Wwk order and a
fim of 5100.00 at day againA ttte
For dq=t nmMd sae ootY
Permit Number
14`�Jc Map# Lot#
Signata re of LiccuseelPermitle Date
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:
II. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This —I== to be filled in
by the Banding Department
Required l
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
&Paved Paz-kin 9i
# of Parking Spaces
f of Loading Docks
Fill:
4vo1-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DAVE: APPLICANT's SIGNATURE
NOTE: lssuano of a zoning permit does not relieve an applioant's burde to oom wlt
zoning requirements and obtain all required p1Y fA 011
q permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appliooble permit granting authorities.
FILE if
Fi l e No. C,-
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: �! u/ ✓Vo '`y9 Telephone-
2. Owner of Property:
Address: L1 C04'j1e,5 )ep ''¢Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
Cllbo� ,vG Q �
4. Job Location: 3�' /✓U�' � G�7 �a 70�
Parcel Id: Zoning Map# ��`.> // Parcel# District(s): -
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed UseMork/Project/Occupation: (Use additional sheets if necessary):
--v/ N'/ sj'o'i rr'-6,
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/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)
39 WOODBINE AVE BP-2000-0406
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25A- 153 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:vinyl siding BUILDING PERMIT
Permit# BP-2000-0406
Project# JS-2000-0699
Est.Cost:$7700.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: B & R Siding 100465
Lot Size(sg ft.): 4878.72 Owner: HAIGLER JUDY
Zoninc:URB Applicant: B & R Siding
AL:_aj WOODBINE AVE
Applicant Address: Phone: Insurance:
781 Bridge Rd (413) 586-4167 Workers Compensation
NORTHAMPTON 01062 ISSUED ON.io/1911999 o:oo:oo
TO PERFORM THE FOLLOWING WORK.-INSTALL VINYL SIDING
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 10/19/1999 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo