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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 7�7�� '��'� Alterations
a NORTHAMPTON, MASS. �LY V-- 19F/" Additions
APPLICATION FOR PERMIT TO ALTER Repair
� / Garage
1. Location /" Uy � ,e" /Ile Lot No.
2. Owner's name SIC kafxwco-�i Address a�7
3. Builder's name Address
y ?�707 Expiration Date O�✓
4. Addition
5. Alteration Vi,V,/
6. New Porch
7. Is existing building to be demolished?
S. 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:- S�
O
The undersigned certifies that the above statcmcnts are true to the best of h
knowledge and belief.
Signature of responsible app.icant
Remarks
♦" . � _ A y:5
e 71999
DEPARTMENT OF BUILDWG INSPECTIONS
sl, 212 Main Street ' Municipal Building '
Northampton, Mass. 01060 '
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(liceusu/perini U ee}
with a principal place of business/residence at:
5 � �4 Fe- �"/ /- i (phone-9)
(StI=t/ci ty/S tair/ri p)
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:
(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 Compaay/Policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additioml shoot if ncocxssry to include adocrostioa pertaining to all ooatrz d )
(kf 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 award chid whilo homcowam who ctnploy perzoas to do M.;,jca cr construction or rcpair work on s dwelling of
not morn than thtoo units in which the homeowner resides or oa the grounds appuctea thercto arc oot gcacnlly coandcrcd to be
employes under tbo work 's won Act(GL152,ms 1(5))�application by a homeowner for a tiecnse or permii may cvidcnoc the
Icgal aiahts of an employer underthe Wockcet Compensation Act_
I undcridAnd that a oopy of this rulcmcni may be foewarxW to tho Departmm2 of Dottier!AttW--&OiSoe of Iaxusooe for the
coverage verification and tbat kilt=to secure covaAgo under soctioa 25A of MOL 152 can lead to tbd imposition of criminal penalties
-austmg of a fine of up to S 1,500.00 and/or imprisoomwi of up to one year and civil pcnaltia in the form of a Stop Work Order sad a :1
Sum of S 100.00 a day tgaiaA mo.
For dgmtmmW use oatY
Permit Number
171
Map# Lot#
-;411 S of Ucenscc1Pcrmittcc nate
10. Do any signs exist on the property? YES NO v
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES.
IF YES,describe size,type and location:.
NO
11 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This colnam to be filled in
by the Building Uepnrtment
�� . L,c.rLli.lcaLion: i neredy certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: % � APPLICANT's SIGNATURE
NOTE: issuance of a zoning permit does not relieve an ap lionnt's burden to comply wit"'4�111
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
• r
FILE #
Existing
Proposed
rcequirea
By Zoning
Lot size
Frontage
Setbacks
- side
L: R:
L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&p=eed parking)
# of -Parking spaces
# of Loading Docks
Fill:
4 volume--& location)
�� . L,c.rLli.lcaLion: i neredy certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: % � APPLICANT's SIGNATURE
NOTE: issuance of a zoning permit does not relieve an ap lionnt's burden to comply wit"'4�111
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
• r
FILE #
JUL 7 1999
File No., ,o e 1
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: d�� l�/',770`'7
Address: � '�� S� re '���� Telephone: y/3
2. Owner of Property: A 4c�/ /
Address: ,/ r% ' ��C &&x`-Telephone:
3. Status of Applicant: Owner Contract Purchasers Lessee
f/ Other(explain):
4. Job Location:
Parcel Id: Zoning Map#__jAd,__. Parcel# District(s):_
(TO BE FILLED IN BY THE BU DING/DEPARTMENT
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
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 KN0A 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 f/ 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)
w
23 MARY JANE LANE BP-2000-0014
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 12C-071 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Cate og ry:"inyl siding BUILDING PERMIT
Permit# BP-2000-0014
Project# JS-2000-0015
Est. Cost:$5000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: TODD BOYNTON 126807
Lot Size(sq. ft.): 10018.80 Owner: WARYWOSKI SOPHIE S
Zoning: APP licant• TODD BOYNTON
AT:
—21 MARY JANE LANE
Applicant Address: Phone: Insurance:
83 SILVER ST (413) 772-8829
GREENFIELD 01301 ISSUED ON.•7/8/1999 om: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:
R
Final: Final: 1,
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 7/8/1999 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo