17C-253 (7) �itwrnT
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m DEPARTMENT OP BUILDING INSPECTIONS —
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORICER'S COMPENSATION INSURA-NCE &FF1)AN7rr
(1 i ccrlsra��crm i tire)
NvIfl1 a principal place of business/residcncc at:
--- --- -- ----- -- -- —(1>1)0 n 00
(strU�t/cite/n tc/zip)
do hereby certify, under the pains and penalties of'perjtily, thai.
( am an erlaployer providing the followins; V. 1, I,01 compensation coverage for my
employees wolf-llg on this job:
D/ of o
(Insurance Company) (Policy NIumber) (Expiration Date)
O 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) �nsuranc_- Company/Policy Number) (Expiration Date)
(Name of Contractor) (Lasuranoc Company/?obey Number) (Expiration Date)
(Name of Contractor) (lnsumnc_- Compan y/Policy Nttmlxr) (Expiration Date)
(Name of Contractor) (Insutan Company/Policy Numtrs) (E)gAmtion Date)
(anach addiGi l d)-od if mto=dry to include infer-mi:ioo pertaining to dll ocrl;rn ton)
O I am a sole proprietor and have no one workng for me.
( ) I am a home otivner performing aH the work myself
NOTE:please be aware that ttiaito bomernwcrs�r,bo employ persons to M mahAcwncr,ma3tuc6o3 or rrpzi work on a d.+clling of
not mote th-n throe units in tclrich the l»atoowocr residcs or co the grounds xppurtcaiat tbacto arc no(wally coaridcsed to be
employrrs under the tvorkcr`s 0MTC isaticn Act(GL152"1(5)1 appticapon by n homcow=for a liocase cc pertnii may evidence the
lcgsl et2ftsa of an employor under the Wortcoc's Compo,,J i Ad
I un<i s d thai a copy of thi,rtitcmcnt may 1w focwvded to tho Dcpartm,o2 of Ls&L t6d Aoadmr&Off oo of lavmADcc for the
oovaxge verificstioa and that failure to t:ecttrc oovcrnbro under stc6oa 25A of MGL 152 can lwt to the imposi6oa of erimi-I penalties `
ooadviag of I fnc of up to S1,500.00 andlor imprisorrma of up to ooe year and civil pc Wc3 in the form of a Stop Wort Ordcr and a
fine of S 100.00 a day agtinst me
,{rye� aoob
Signed 1�/_day of r'/ ' v/ Fordcpatma U9.0«rly
Permit Number
MapM Lot 9
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
4 ao00
NORTHAMPTON, MASS. u� aI
�.�- Additions
APPLICa ATION FOR PERMIT TO ALTER
Repair
`A 'A Garage
rl
1. Location ct 10 1 � /"` Lot No..,
2. Owner's name � iG�-- (Ad dress`s G 73 CvakY—S Ge /,4.
3. Builder's name U eoolm Address IRK L) �OVJ
Mass.Construction Supervisor's License No. bI I M Expiration Date sky b/
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
m 12. Type of roof rE% [l
13. Siding house
14. Estimated cost- 00
��V[J The undersigned certifies that the above statements are we to the best of his
knowledge and belie j,7
)q?qjj0e of responsible app icant
Remarks
Brost on the roe YES No
10. Do any signs p p property?. E
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 col== to be fillod in
by the Building Dcpartmcat
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - front
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
9*f parking spaces
of Loading pocks
Fill:
.�voldme--& location)
13 . Certification: I hereby certify that the information contained herein
4,
is true and accurate to the best of my know edge.
DATE: APPLICANT's SIGNATURE
NOTE. tuasuanocz of a zoning permit does not relieve nn applionnr bur a t mpty with all
xoning requirement" cand obtain call required permit" from the 13ourd of Health, Conaiervation
Comminalon, lbepsqkrtment of Publio Wor" Lind other opplio"bic permit granting authoritiea.
FILE if .
File No.
ZONING PERMIT APPLICATION (§.10 . 2)
PLEASE TYP,EJ OR PRINT ALL -TNFORMATION
1. Name of Applicant: �0 ( V
Address: 2>;c,S ATelephone: gf3'!AL1'1AV
2. Owner of Property: NI e rU (a FICwt v,
Address: ul� �{���/ X(q Telephone: q13 -
3. Status of Appli t: Owner Contract Purchasers /Lessee
/Other(explain):_ �( j✓ ( �YJ?�GfCC�I�
4. Job Location:
Parcel Id: Zoning Map# Parcel District(s):
(TO BE FILLED iN BY THE BUILDING DEPARTMENT)
- �,,,
5. Existing Use of Structure/Property S
—� •
6. Description of Proposed Use/Work/ProjecUOccupabon: (Use additional sheets if necessary):
Oar lllellv)'60� 6W.
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the roltowing 2 questions may be obtained by checking with the[wilding Dept or Planning Department Files.
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO — DON'T KNOW__ J 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)
y
29 NORTH MAIN ST BP-2000-0792
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map-.Block: 17C-253 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:roofing BUILDING PERMIT
Permit# BP-2000-0792
Project JS-2000-1488
Est.Cost: $9300.00
Fee:$50.00 PERMISSION IS HEREBY GRANTED TO
Const. Class: Contractor: License:
Use Group: Young Roofing Co Inc 011878
Lot Size sq.ft.): 18948.60 Owner: HEROCHIK MAE
Zoning. URB Applicant: Young Roofing Co Inc
AT: 29 NORTH MAIN ST
Applicant Address: Phone: Insurance:
P O Box 56 (413) 584-1367 Workers Compensation
FLORENCEMA01062 ISSUED ON:3121100 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL NEW CARLISLE MEMBRANE ROOF
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 3/21/00 0:00:00 9567 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo