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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. �� 19LL Additions
% Repair
' APPLICATION FOR PERMIT TO ALTER
/ �/ Garage
1. Location V a U`�aj )r '4U� llw t '4.#,0 �°) �� Lot No.
2. Owner's name_ �a� � 2 Address =v is dt7�l vl l�G
3. Builder's name 8:5L de s rJ:, ��`'� Address �S� � ' awl 9 7'6�t1
Mass.Construction Supervisor's License No. �+6 $�� Expiration Date O�~97 Oy a
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 cost:- G jpb °✓
The undersigned certifies that the above statcmcnts are true to the best of
knowledge and belief.
Signature of responsible appieont
Remarks
�°e`er oti
s
-
' OCT 1 9 1999
� '� �lxssxchnsctts
0 ; DEPARTMENT OF BUILDITIG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, E0—W.0 L '3 q /'1 8-4 d2 S/a/do z TW C-
'taenserlpermittee}
with a principal /place of business/residence at:
/" *- (phone#) 5"96 '-t//lam°7
(street/ ty/stafe%p)
do hereby certify, under the pains and penalties of penury, that:
(i I am an employer providing the following worker's compensation coverage for my
employees workng 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) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(aituh additional sheet if neoeaary to inechide information putaining to all ooubmc on)
( ) 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 homeowners who employ pasom to do m&mb ■+m wnshmc ion or rrpairwork on a dwelling of
W more than throe vans is which the homeowner raids a an the grounds appurtenant thacto ate not generally 000nderod to be
employers under the worker's oompeastuon Act(GL152,ss 1(5)),application by a homeowas for a lieeme or permit may evidcaa the
legal xtataa of as employer under the Woes Compensation Aot_
I undeostaad that a copy of this statemeat any be forty aded to the Depuftaca2 of Industrial Aecideo&011ioe of kaw*ace for the
coverage verification sad that failure to secure coveatgo under secdoa 25A of MOL 152 can lud to tba iarpositioa of aimiaal pemlties
oonsisiang of a fine of up to S1,500.00 aadlor kaprisoomerl of up to ono year and civil pangWcs is the form of a Stop Work Ord=and a
fine of 5100.00 a day against me.
For dMatn=W use caly
Permit Number
Lot#
Sure of Li
ceaseelPe tzce Mte
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:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This cols to be filled is
by the Building Department
Required
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 parkingi
# 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.
DA3 E X APPLICANT's SIGNATURE �
NOTE: lssuanoe of a zoning permit does not relieve an applioanYs burden comply witF��all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appiloabla permit granting authorities.
FILE #
OCT 1 91999 t
File No.
d
mu,, N. NG PERMIT APPLICATION (§10 . 2)
.PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: �` ✓ S/A��q
Address: �7 � �G�a .Q� '� A/n 1l,qmD7ot Af Telephone: ,�u'w4 7
2. Owner of Property:
Address: �/ L����ts 0 `� /��"�� i, Telephone: S ' 306/
3. Status of Applicant: Owner z.,'/Contract Purchaser Lessee
Other(explain):
4. Job Location: z/ woE,4,0/, U AM 1 rr -75� J
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 Use/Work/Project/Occupation: (Use additional sheets if necessary):
. V/ nJ/I s1j.� 0 - -
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)
41 WOODBINE AVE BP-2000-0405
GIS#: COMMONWEALTH OF MASSACHUSETTS
MU.Block: 25A- 154 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:vinl siding BUILDING PERMIT
Permit# BP-2000-0405
Project# JS-2000-0697
Est.Cost: $6900.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: B & R Siding 100465
Lot Size(sa.ft.): 3963.96 Owner: HAIGLER JUDY
Zoning URB Applicant: B & R Siding
AT. 41 WOODBINE AVE
Applicant Address: Phone: Insurance:
781 Bridge Rd. (413) 586-4167 Workers Compensation
NORTHAMPTON 01062 ISSUED ON.io/19/19990:0o: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