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25C-059 INSPECTION SERVICES AFFIDAVIT Ilome Improvement Contractor I.nw Supplement to Permit Application MW-C.14LA tcquirca lhal the'reconstruc(ion alteration renovation repair modernimlion conversion,Inprovemeni,removal,demolition, Qr construction of an addition to any pre-aislinX owncroccupicd building conlainintat Ices(one but not more Than four dwelling unils....or to struc(utcs which arc adjacent to such te3idenee or building he done try rrrklered contraoom.with certain eaceplions,along with ocher requiremenu. J Type or work iv r 1N1 S f/� s On��-`s�o�`Cj Est. Cost o�✓�� Address of Work !AJ rl N .�G Owncr Namc: AL 4 6 Date of Permit Application: 1 hereby certify that: Registration is not required for the following rc1son(s): Work excluded by law _Job under SI,fXXI Building not owncr-occupied ,zorwner pulling own permit _Other (specify) Noticc is hcrchy given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE I IOME IMPROVEMENT WORK DO NOT HAVE ACCESS 1*0 TI IE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL f c. 142A. Signed under penalties of perjury: I hereby apply fora permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the Mabovcollcc, hereby 3plyly for /acrmil as the owner of the ahovc property: Datc O lcr N. lc 0 > o 0 m 3 c o > > > 1 Ln o ::E c c � Zoning Miscellaneous Additions, Repairs,Alterations,etc. Tel.No. A� Alterations NORTHAMPTON, MASS. 'a 191 Additions APPLICATION FOR PERMIT TO ALTER Repair Garage 1. Location ` /�/ (r7 @ y'J Lot No. 2. Owner's name t)C �7 "�� � fj#t Address l q G i,,-s lyJ.J lZ j 3. Builder's name '�- Address Mass.Construction Supervisor's License N( -- Expiration Date 4. Addition i 5. Alteration ti � X3-/" 4 4- t C4.J te � �4 6. New Porch ' 7. Is existing building to be demolished? 8. Repair after the fire 9. Garage No.of cars Size It 10. Method of heating 11. Distance to lot lines 12. Type of roof 13. Siding house 14. Estimated cost:- 500 < r The undersigned certifies that the above statements are we to the best of his knowled and belief. j i nalure 11,� ons,ble app icani Remarks 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: X1 . ALL INFORMATION MAST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. This coluam to be filled in by the Building Department Required Existing proposed By Zoning Lot size Frontage Setbacks n 1" - side L: R: L: R: - rear Building height Bldg Square footage %Open Space: (Lot area minus bldg &paved parking) # pf -Parking Spaces # fof Loading Docks Fill: -(volume -& location) 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. _a DATE: 4 W APPLICANT's SIGNATURE NOTE: tssuanoe of zoning permit does not relieve an ap Y bur n to mply wilt?_all zoning'r,"ulrements and obtain call required permits from "B rd Health, Conservotion Commission, Department of Publio Works and other applio bl© 'ermit granting nuthorition. FILE # y DEC 2 7 I9d File No. L�L `H 1..... ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: / Address: L�kJ el'OL" ' Telephone: t;64 627,3 C7 2. Owner of Property: Address: Telephone: 3. Status of Applicant: yOwner Contract Purchaser Lessee Other (explain): / y' 4. Job Location: 1 h f K• l0 /N �" Parcel Id: Zoning Map# )-J 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): 1�dcj C4 rb<,vc A i-s je^�J— . j/41 / o,) 111"0C1-3LA'e_r 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/Variance/Finding ever been issued for/on the site? NO (--` DON'T KNOW YES IF YES,date issued: IF YES: Was t 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-2000-0612 APPLICANT/CONTACT PERSON HEATH JEFFREY M&EDNA M ADDRESS/PHONE 19 LINCOLN AVE (413)586-2730 Q PROPERTY LOCATION 19 LINCOLN AVE MAP 25C PARCEL 059 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildina Permit Filled out Fee Paid 113,5- �- jypeof Construction: ADD CABINETS UNDER ISLAND&NEW COUNTERTOPS New Construction Non Structural interior renovations Addition to Existing - Accessory Structure Buildina Plans Included: Owner/Statement or License 3se/sets of Plans/Plot Plan TIJE�OLLOWING 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 Comm' 'on Signature of Building Official Date YR LO 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. 19 LINCOLN AVE BP-2000-0612 GIS#: COMMONWEALTH OF MASSACHUSETTS MQ�Block: 25C-059 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2000-0612 Project# JS-2000-1088 Est.Cost:$2500.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor., License: Use Group: Lot Size(sy. ft.): 4660.92 Owner: HEATH JEFFREY M&EDNA M Zoning:URB Applicant: HEATH JEFFREY M & EDNA M AT.• 19 LINCOLN AVE Applicant Address: Phone: Insurance: ISSUED ON.113100 0:00:00 TO PERFORM THE FOLLOWING WORK.-ADD CABINETS UNDER ISLAND & NEW COUNTERTOPS 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: 00*- Building 1/3/00 0:00:00 11356 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo