25C-088 (3) a
.. n
m
a
0 3 OZm
r r•
L o
o
Fri �
�.
Zoning
Miscellaneous Additions,Repairs,Alterations,etc. 7 Tel.No. Alterations
NORTHAMPTON, MASS. , 19 V Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location Lot No.
2. Owner's name �� B �� �- v !" � Address
3. Builder's name �� _ Address
Mass.Construction Supervisor's License No. 0 l y6/-1 Expiration Date
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.
Signature of responsible app,icant
Remarks
�t1AMpT o
o oy GrZf-R of Nort4anipttm
-O:a::cqusctis
.7MENT OF BUILDMG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
Ncenscelpermittee}
with a principal place of business/residence at:
( � CvC�-cam ✓/' ` .rte e��CQ. (phone
(stz-eet/city/statr/ap)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following workers 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) (Insurance Company/PoLicy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additioml sheet ifneeeuary to include information pertaining to all 000tracton)
VY-fam 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 whilo homeowners who employ pa-wns to do mainica v r c=wuctioa or repair work on a dwelling of
not morn than throe units is which the homeowner midi or cc the groin appudenaat thereto arc not gaxrally ooasidcrcd to be
employers trader tha worker`s compenw4ea Act(GL152,m 1(5)),application by a homeowner for a license or permit may evidenoc the
legal stabs of as employer under the Workeet Compensation Act
I understand that a copy of this rutemad may be forwarded to the Dcpwtmaot of Wwftid Accidents'Offioe of ln"w ce for the
oovaige verification and that failures to too=covaago under soctroa 25A of MOL 152 can lead to the impos—of aimiaal pen M's
ooasutiag of a fine of up to$1,500.00 and/or imprisoomart of up to one year and civil penalties is the form of a Stop Work Order and a :1
fma of 5100.00 a day against me.
For dcptatntrmtal use Only
Permit Number
Map# Lot#
;1
Date
Signature of Licensce/Permittee
AAe-
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 COITU= to be filled in
by the Building Department
I Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&Paned parkingi
# of -Parking spaces
#
of 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.
DATE: - �F 9 APPLICANT's SIGNATURE p,
NOTE: 1 nuance of a zoning permit does not relieve an applioant's burden to comply With'4111
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission. Department of Publio Works and other applioable permit granting authorities.
FILE #
File NO. ✓ !(�U
SUN 319
O ING PERMIT APPLICATION (§10 . 2)
t;ErYM� ,�pd1 6�
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: Y Cl: •_ � �
Address: t
' '�U }j y Telephone:
2. Owner of Property: a -
Address:
kl ;? <. 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 BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
fi &�-&
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 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-1999-1027
APPLICANT/CONTACT PERSON DA Williams
ADDRESS/PHONE 81 Water St. (413)586-3139
PROPERTY LOCATION 22 LINCOLN AVE
MAP 25C PARCEL 088 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid _1—o
Typeof Construction: REMODEL BATH
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
TH�FLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
ved as presented/based on information presented.
Denied as presented: G j
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 Commissio
Y
Signature of Bu ng 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.
22 LINCOLN AVE BP-1999-1027
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25C-088 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-1999-1027
Project# JS-1999-1743
Est.Cost: $2400.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: DA Williams 014612
Lot Size(sg. ft.): 6621.12 Owner: PETRIN ADELAIDE P
Zoning:URB Applicant. DA Williams
AT: 22 LINCOLN AVE
Applicant Address: Phone: Insurance:
81 Water St. (413) 586-3139
LEEDS 01053 ISSUED ON.'6/9/1999 o:oo:oo
TO PERFORM THE FOLLOWING WORK.-REMODEL BATH
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 6/9/1999 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo