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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location //p n��'� A L4;e/� Sk Lot No.
2. Owner's name )Qa U i d ,la U-' Address ( 6 I'yo, )e e��
3. Builder's name �V rti. ate.�� Address
Mass.Construction Supervisor's License No. L? Expiration Date---d-7
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 S�w i P �/ , �I N.L"1a Za 0 Zlq�o e a, , y®
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are we to the best of his,
knowledge and belief.
Signature of responsible app,ican/
Remarks
�Cl1AMP�.
Boo ° 9 Gf it oaf d,zz#E�ttnt nn L
9 6 �csaachnsctla
u, DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060 '
WORKER'S COMPENSATION MSURAI`ICE A i ' AVIT
(licensecJpermi��ee)
with a principal place of business/residence at:
-7 64LMs,54 & #aX�j
(sires- city strap)
do hereby certify, under the pains and penalties of penury, 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 Compauy/Policy Number) (Expirntion Date)
(Name of Contractor) (Insurance Compary/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compa ry/Policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheet ifnoo=ury to tod idc informiIIon pt.a to all ooatractors)
(L�'I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:pleaao be aware that whilo homcowvcn Niw employ pazom to do mxadcaxacr,ronstN=on or repair work oa a dwelling of
not mote than tbrne units is which the homeowner residca or oo the grounds appurtenant th=w arc not generally wandcrcd to be
employes under the worktt comp=s4on Act(GL152,s 1(5)),application by a homeowner for a boenx cc permit may evidence the
legal antLu of an employer under the Woricods Compmaaiion Act
I undasdaad that n oopy of thu ctalemmt may be fo.wnrded to tho Doputmmd of Industrial Apddm&Off oe of Inzsus000 foe th.
oov=ge vc6ficatioo and that fail=to town covcrngo umdcr socUoa 25A of MOIL 152 can Iad to tbo imposition of c-aiaal pcaaltics
ooaustmg of a.'finc of up to S 1,500.00 andloc of tip to one yrsr and civil pcmitia in the form of a Stop Work Order and a ,
firm 0(5100.00 t day against me_
Foe use only
Permit Number
% d a`� 9 Mao_.__��_rat#
Signature of Li etmiticc
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 C01tX= to be Pi11ed in
by the Building Department
I IRequired I
Existing Proposed By Zoning
I 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
# of Loading Docks
Fill:
-4 volume -& location)
13 . Certification: I hereby certify that the information contained herein
�r is true and accurate to the best of my knowledge.
_a
DATE: 3 rj _ APPLICANT'S SIGNATURE ` o�
NOTE: las anoa of a zoning permit does not relieve a applioanYs rden to oompty With sill
zoning requirements and obtain all required permits from the 130a0d of Health. Conservotion
Commission. Department of Publio Works and other applioable permit granting authorities.
FILE #
File No.
9
ZONING PE=T APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: G° "r✓ b Telephone:_
2. Owner of Property: oQd y d Rein do s"
Address: //0 sj- Telephone:
3. Status of Applicant: Owner t l Contract Purchaser Lessee
Other(explain):
4. Job Location: // y
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Pro osed Use/Work/Project/Occupation: (Use additional sheets if necessary):_
Ll
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/Vahance/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)
.. w
110 NORTH MAPLE ST BP-1999-0792
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C-016 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:roofing BUILDING PERMIT
Permit# BP-1999-0792
Project# JS-1999-0166
Est.Cost: $18000.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Quinlan Builders 011289
Lot Size(sg. ft.): 21387.96 Owner: BEAVER DONALD DEB&DAVID E
Zoning:URB Applicant: Quinlan Builders
AT: 110 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
5 Hillside Dr (413) 585-0949
HADLEY 01035 ISSUED ON.3129/1999 o:oo:oo
TO PERFORM THE FOLLOWING WORK.-STRIP SLATE INSTALL 1/2" CDX & 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 3/29/1999 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo