17B-025 (2) Aug 23 '99 12:59 P.01
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DEPARTMENT Of BUILDING INSPICt10NS
212 Main Street ' M%micipal Building
Northampton, Mass. OIG60
WORKER'S COMPENSAITON INSURANCE AFTI DAVr
1, �lA� �-�►��z"1✓3 �cZ.=1 ��f' --
(li cen_serJperrr►i flee)
with a principal place of business/residence at:
A
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(st�et/ei tylstatcl�p)
do hereby certify, under the puns and penalties of perpkr , that:
( ) I am an employer providing the folloWwi g worker's compensation coverage for my
emplovees working on this job:
�c r�� � r� `L--✓� 5 i l��ESi� � � U-2 f��
(InMU-Anne CotuPany) (Policy Number) ti Dau)
( ) I atn a sole proprietor, gcncral contractor or homeowner(circle one) and have hired
the eoatractorslisted below wbo have the following worker`s compensation policies:
(Naime ofC-CmWactor) (instuanccCmnV=y/Pob"Number) (Expiration Dalc)
(Name of Eoutracttor) (lztsumce CompamrfFabcy Number) (Expiration Date)
(Name of Conmctor) (Insurance Cotvpany/PoUcy Number) (Exp"doo Datc)
—(Name-of Contzacw �ComwyRouq Humber) (Expiration Date)
(anaeh ad"OWJ abed d'ce.='Lrr to iocludc idorm.o 0o pertain to all 000mulan)
( ) I am a sole proprietor and bave no ope working for me..
( ) X am a home owner perforraing.all-the_worlc myself
NOTL-please ba arise that wW9 bovowwam wbo emgloy.pasom to do W fcpmk work on a dwelling or
not awn than tboa unite a which the howoowner rcvAcs or oa the vmuudf appwttrna l tberda at wC9coa&4 OOarA=410 be
ecopioytm1i tsaivoriia Laoy=tim rfa t6Lr57Asti5"i)6"Iffi—itm by a.baaansrmtos b t; Of W-W
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I uadgstasd tha.a aoyy old"ear®=m.y be ror.wd.d to the vorolumet of t.dustrid Ae"wmf OM«of ras'aama tq in
avndAwk fa-amre&a=me ecrt3 w and $=ties!,A of MOL►52 rsa` ••.��_'i=*WW='tf a+adi 4melf6a
oomaoteg ors f w%f tap b S13co ne=Nor jmp r of ap to eoe year and avt7 pesaim it�a rbrm nfR Stop Wlotk Ontrr anti a
i t7rst�Q.�tt t day 4picA
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 1 g Additions
Repair
' APPLICATION FOR PERMIT TO ALTER
�/ 2 ^ Garage
1. Location 7 S (�ro�Se `d Lot No.
2. Owner's name L Co f ✓() Address [0 ,
3. Builder's name k JA M c"�'«'� ��° Address C'0 00
Mass.Construction Supervisor's License No. 4= d--4 Expiration Date ;z t
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 Sett S T 5'
13. Siding house
14. Estimated cost- 5'I
The undersigned certifies that the above statements are true to the best of his,
knowledge lief
Signature of responsible app,ic nt
Remarks I W
10. Do any signs ebst 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
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This —.I== to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
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 co tai d herein
is true and accurate to the best of my knowle e
DATE: :-% APPLICANT's SIGNATURE
NOTE: Issuanoe f a z Wing permit does not relieve an a lioant's burden io oomply wit47011
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commisslon, Department of Publio Works and other applionble permit granting authorities.
FILE #
.l
3 Bye)
File No. (�
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: B L) bc4 6 Telephone: S�o17" �3
2. Owner of Property:
e
P
Address: L—( y'5 D d rd Telephone:
3. Status of Applicant: Owner tract Purchaser Lessee
Other(explain):
4. Job Location: 8f'd,--, e
Parcel Id: Zoning Map# Z Parcel# ,- District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property f'� L"
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
Ir r h
44-
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 perrlit 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)
mow. 4
4
485 BRIDGE RD BP-2000-0192
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17B-025 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Cat aorv:roofing BUILDING PERMIT
Permit# BP-2000-0192
Proiect# JS-2000-0313
Est.Cost: $5000.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Adam Quenneville 120982
Lot Size(sa.ft.): 21736.44 Owner: CROVO ROBERT A&ELIZABETH A
Zoning:URB Applicant; Adam Quenneville
AT• 485 BRIDGE RD
Applicant Address: Phone: Insurance:
P O BOX 612 (413) 527-8375
SOUTH HADLEY 01075 ISSUED ON.812311999 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE 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 8/23/1999 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo