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TILE FLOOR INTO HALL A LSPRA CEILINGS Z 30" OPEN GLASS SHELVES
BATH RECESSED HALOGEN LIGHT
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31 Tl CARNES KITCHEN REMODEL
277 AUDUBON RD . LEEDS
584-0198 11 - 19-99
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277 AUDUBON RD . LEEDS
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Zoning
Miscellaneous Additions, Repairs,Alterations,etc. Tel.No. " Z Alterations
NORTHAMPTON, MASS. �Lf ���/7/G ? 000 Additions
APPLICATION FOR PERMIT TO ALTER Repair
a
Garage
1. Location �� � GG%� /�J , ,�.L� Lot No.
2. Owner's name X// �l�Y/� - 17� l/��/1�-.S Address_ 277
3. Builder's name y
'try/.--�:''/tz�nZ� .��'/�/��'IJ�'c`�L��Ji, .�"�1G Address e/G'f,e-4's�f
Mass.Construction Supervisor's License No. �11c Q �o� Expiration Date_ /7�G�C>
4. Addition
5. Alteration �f.'r'/rl l?C G� / .. ✓C e'I?cI QUL J°r �C[-ts (�,N CyGM!
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 n
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his
knowledge and belief.
Signature of responsible app,icanr
Remarks
0 0CtU�1I Pip
�asaac(Tnsrtta
m DEPARTMENT OP BUILDITNC INSPECTIONS
212 Main Street a Municipal Building '
Northampton, Mass. 01060 '
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, Nelson A. Shifflett / Valley Home Improvement, Inc.
(Lccnsec/permittec)
with a principal place of business/residence at:
320 Riverside Drive Northampton, MA 01060 (phone#) (413) 584-7522
(str _t/ci ty/stat�i p)
do hereby certify, under the pains and penalties of perJury, that:
M I am an employer providing the following worker's compensation coverage for my
employees working on this job:
Travelers Insurance Co. U13888139983 2/1/00
(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) (Insurancc Company/Pohcy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additiccW shoe if no=isy to include information pertaining to all ooatrndors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:plea=be aware that whilo homeowners who employ pasow to do mainica=c,corMructioa or rcpair work on a dwelling of
not more than throe units is which the bontoowncr r=dm or on tho g wands appurtenant thereto are not gcoerally ooandered to be
employers under the wotic.cez omnpensation Ad(GL152,ss 1(5)),application by a homeowner for a license or permit may evidenoe tho
legal status of an employer under the Worlear'a Compe os&i Act
I undauand that a oopy of this etatement may be forwruded to tho DoptL t of Indudrinl Aaadm&Offioc of Inxuanoe for the
coverage vrrificstioa and that failure to soatre oovaago lmdcr soctiom 25A of MOL 152 can lead to the imposition of criminal penalties
oonist of a fine of up to S 1.5oo.00 andtor imprisonment of up to one year and civil pa Wcs in the form of a stop Work order and a
faro of S 100.00 a day against tae.
Signed this `day of_ 1999 For dgmtmmhl use only
Pcrmit Number
Map# Lot#
Signature of Li cant tee
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 MAST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This column to be filled in
by the Building Department
Required
Existing Proposed ►`• By Zoning
Lot size
Frontage Q
Aj
Setbacks
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parkingi
# of Parking Spaces
# r8 Loading Docks
Fill:
-(volume -& location)
13 . Certification: I hereby certify that the information contained herein
1� is true and accurate to the best of my knowledge.
DATE: / " �1 w APPLICANT's SIGNATURE
NOTE: lasuanoe of as zoning permit does not relieve an applioanir burden to oomply witlj all
zoning requlrements and obtain all required permits from the B and of Health. Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
, r
File No. � ' t
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:!//%��
G�' 4�X lr Ala 2 UIVG
Address: 3� ,� <S'/J� �� /CG'.� lam. lia°'/i elephone: � � Z Z-
2. Owner of Property:
Address:��1/ 11� z Telephone: L:��e?�V
3. Status of Applicant: Owner/o Contract Purchaser Lessee
V ic Other(explain):
4. Job Location: ��/ / ,1�G��Gf°L/ . f0 S_��
Parcel Id: Zoning Map# Parcel#_ District(s): �
(TO BE FILLED IN BY THE BUILDING) DEPARTMENT)
5. Existing Use of Structure/Property NS J V Frm
6. Descriptiopq of Pro os d U or roject/Occupation: (Use additional sheets if necessary):
S n _ /Cr !Al —
7. Attached Plans: 'mss 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 PermiWadance/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)
File#BP-2000-0674
APPLICANT/CONTACT PERSON Valley Home Improvement,Inc
ADDRESS/PHONE P O Box 60627 (413)584-7522
PROPERTY LOCATION 277 AUDUBON RD
MAP 05 PARCEL 019 ZONE RR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid //;Z75- /4
Typeof Construction: REMODEL KITCHEN REMOVE DOOR,INSTALL NEW WINDOW
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 060300
3 sets of Plans/Plot Plan
THE F 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
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Co 1 on
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve 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.
r
277 AUDUBON RD BP-2000-0674
CIS#: COMMONWEALTH OF MASSACHUSETTS
oowolap.Block: 05-019 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category'Non structural interior renovations BUILDING PERMIT
Permit# BP-2000-0674
Project# JS-2000-1245
Est.Cost: $20000.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Valley Home Improvement, Inc 060300
Lot Size(sq. ft.): 273992.40 Owner: CARNES RICHARD CHARLES&EMMAJ
Zoning,: Applicant.• Valley Home Improvement, Inc
AT. 277 AUDUBON RD
Applicant Address: Phone: Insurance:
P 0 Box 60627 (41-A) 584-7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON:211100 0:00:00
TO PERFORM THE FOLLOWING WORK:REMODEL KITCHEN,REMOVE DOOR,INSTALL
NEW WINDOW
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 Deoartment 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:
cc
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo