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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. ;7f Z Z Alterations
NORTHAMPTON, MASS. - cq 192d Additions
a APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location ` Z/f L f r Lot No.
2. Owner's name .1`'iJ� � ' '�fl-[3iAr C,9�4JA",-4, Z—/0Address /I/ f S�ffT
3. Builder's name hff-4Sot/9,'11 aETY' U/Ikz.0'/rows r Address �-U <114W1bf,M. �f/D/2llff3�l/�i7�•t;//1ff d/l�Ho
Mass.Construction Supervisor's License No. G' �' �� Expiration Date Jf1 ao
4. Addition
5. Alteration y yS �/
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 /d/ i
12. Type of roof
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
VA k&Y4-e
Signature of responsible app,icani
Remarks, J*/ i /'
_ 0" Crzf�i of 'Nort11alliptall
R A;
C }itssaarhnsrtls —
DEPARTMENT OP BUILDING INSPECTIONS _
212 Main Street ' Municipal Building
Northampton, Macs. 01060
WOMCER'S COMPENSATION INSURANCE &FIMAVIT
I, Nelson A. Shifflett / Valley Home Improvement, Inc.
(lio=-w/permittcc)
with a principal place of business/residence at:
320 Riverside Drive, Northampton, MA 01060 (phone#) (413) 584-7522
(atTCct/ci ty/statr/bp)
do hereby certify, under the pains and penalties of perjury, that:
n I am an employer providing the following worker's compensation coverage for my
employees working on this job:
Eastern Casualty Ins. Co. WC9660047 2/1/99
Oam=ce Company) (PoGry Number) (Expiration Date)
O I am a sole proprietor, general contractor or homeowner(circle one) and have hired
r
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) Onsurancc Cornpany/PoGcy Numbcr) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Inwmcc Company/Policy Number) (Expiration Date)
(Name of Contractor) ansumcc Company/Policy Number) (Expiration Date)
(attach additional abort if neocuuy to inahuds infaznatioo pertaining to all 000uad )
( ) 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 homeowner who employ pcnona to do wAint�cnmtructioo or repair wait on a twilling of
not more than thr+os unite in which the bomoowncr reaidea or on tho grounds apparten"tbKr arc oot gooaalhy oomirierod to bo
employee under the w+ keez omnprnsatim Act(GLl52.ss 1(5)},applintion by a homoowna fora 1i m e or permit may evidma the
Iegd dams of an•mployr uod•r the Wackaes Compeonation Act.
I uodasund that a copy of thin statcmeot may be forwarded to tho DepariznaA of lndLLStrid Aceidoo Y 0aioe of Imurww f«tie
covas p veriaaiioe and that Allure to secure coverage under section,25A of MGL 152 can lad to the imposition of aimiosl peaaltles
000sirting or a,fine of up to S 1,500.00 and/or imprisoomeni of up to one year and civil pmal6a in the form of a Stop Wort order and a
fine of S 100.00 a day agiinA tae.
Signed this day of 199 For dcpertmo"use odY
] Permit Number
4/n14" hbp# Lot 0
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 colu= to be Pilled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage d4 d E�
Setbacks
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
' &paved parking)
# of _Parking Spaces
f of Loading Docks
Fill:
vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
.1 is true and accurate to the best of my knowledge.
DATE: �_d '`O APPLICANT's SIGNATURE
NOTE:1 suanoe of a zoning permit does not relieve an applicyWo burden to oomply witl7,,pll
zoning requirements and obtain all required permits from the Board of Health, Conservtatlon
Commission, Department of Publio Works and other applionble permit granting authorities.
FILE #
f File No. O/JJ
a5 I
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: Telephone: <fiY X51 z
2. Owner of Property: F�r/�� Li,�'�
Address: 3
ic1 Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
-Other(explain):
4. Job Location:
F
Parcel Id: Zoning Ma # ._'� ? Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)`
5. Existing Use of Structure/Property �J 1 �L' Fd��W.
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
'u v `Zaf/
7. Attached Plans: etch 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 L-'� 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-1999-0135
APPLICANT/CONTACT PERSON Valley Home Improvement Inc
ADDRESS/PHONE P O Box 60627 (413)584-7522
PROPERTY LOCATION 14 ELIZABETH ST
MAP 25C PARCEL 125 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 CIJ( 1 9
Type of Construction:
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Occu ant Statement or License#
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
�+ Well Water Potability Board of Health
Permit from Conservation Commission__ zw 00I.-
�/
r/ �
Signature of Building ial Date '
Note: Issuance of a Zoning permit does not relie�v¢;;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.
Reference No: BP-1999-013.1
Department: ...................................
Building, Electrical & Mechanical Permits
Fee Receipt No:
Non structural interior renovations REC-1999-000239
......................................................................................... ...... ...............................
Paid By: Paid in Full On:
Valley Home lmprovement, .Inc Fri Jul 31,1998
......................................................................................... ......................................
Received By: Check No:
LindaLapointe 9351
......................................................................................... ......................................
DEPARTMENT'S COPY Amount: ...........$40.00...
.. ..........
1)l1PARTM.ENTFILE COPY 14 ELIZABETH ST
CITY OF NORTHAMPTON
BUILDING PERMIT
Owner's pulling their own permits or dealing with unregistered contractors for applicable work do
not have access to Guaranty Fund(MGL 142A)
Issued: Permit No: Inspector: Tracking No.: Fee:
BP-1999-0135 $40.00
GIS Man Block: Lot: Address: Zoning: Use Group: Lot Size:
4505 25C 125 001 14 ELIZABETH ST URB 3354.12
Contractor: License Type: Insurance:
Valley Home Improvement, Inc CSL Workers Compensation
Address: License No.: Insurance No.:
P 0 Box 60627 060300 WC9660047
Liy-i State: Zip Code: Phone:
FLORENCE MA 01062 (413) 584-7522
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0193 Non structural interior renovati $1,500.00
Description of Work:
INSTALL 6' WIDE CASEMENT WINDOW
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: