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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair (9
a
Garage
1. Location CJCC��Cb� (1 ST ��q �-{tom Lot No.
2. Owner's name �i ��5� 'yyxr" Address `–S� � C��
3. Builder's name ®',-�
\���� Address �(I
Mass.Construction Supervisor's License No.�� �o�t L4 C> Expiration Date l
4. Addition
5. Alteration
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-
The undersigned certifies that the above statements are we to the best of hip
knowledge and belief.
Signaturt of responsible appicant
Remarks �4 5 — 7
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p4� T0 0 i s lJ LU {J L5
3
e 6 l JUN 2 4 � . , �assttchnsctta '
X99
,I .
alb j TMENT OF BUILDrNG INSPECTIONS
l n
c r 2 train Street Municipal Building 'o
' 'Northampton, Mass. ' 01060
WORICER'S COoITENSAUON INSURANCE A t ' A.VIT
I, iG M) Kati 171�rrlotj d��s
(I I cen5'C_/pe r m I ttcc)
with a principal place of business/residence at:
D O i+'1 al ,.j /lJ0/f�,4,"fl/o•(phone#)
(str_-Ucity/statdap) M,j Q/G�vO
do hereby certify, under the pains and penalties of perjury, that:
fA) I am an employer providing the following worker's compensation coverage for my ,
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Date)
O I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the follovring worker's compensation policies:
Ginnie (,[Contractor) (Expiration Date)
(Name of Contractor) Nuurl:-,r) (Expiration Datc)
(Name of Contractor) (Insurance. Company/Policy Nwnbt-f) (Expt abon Dale)
(Name of Contactor) (Insure.ncc CompuTy/Policy Nuin mss) (Expiration Date)
(MUCK additicail sheet if ne, au to induc/c infcsvuticn pert�inins to ell cc<emaon)
O I am a sole proprietor and have no one worldng for me.
( ) I am a home owner perfornung all the work myself.
NOTE:please be ague that wbilo bemcouverz wbo uaplay persom•to db,&xiniCa3MCr,cmmbuctioa'or repair%work oo a 6%miliog of
not meco than thteo traits is winch the ivxnoow r=dcc or oa the gtvunrb zpVutra r tkweto are oot gcnmlty oomidced to be
employers under tbo workcrA%oompeasatica Act(GL152ss l(3)�appliation by a botncoRMr for a GC=-oc pumit may-id—the
legit ombn of an employor under tho Wockola CompmI►lion ACL
I uodcntand that a oopy of,thdu rhtca—t m.y be f�dod to the Dcy..rtmmt of Irdautrid Ancid ofJioo of Icxnux for th4
covenge vaifiesfioa and that failure to sea=oovanbv ur,&r station 23A of MOL 152 can IcAd to tbd imposittioo of aiai aW peaal$cs
eoamstmg of a fine of up to S 1.300,00 andloe impriv mnent of tip to one year and avid pcmltia in the fam o[a Stop Work t7rder and a
fmo oC5100.00 a dry against mc.
For uao Cody
Permit Number
I of#, 1
T�� 1
Signahxrt ofLtccn_,cc/Pctmittcc >e
l
10. Do any signs exist on the property? YES NO
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES NO
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION. k$
Thia cols to be filled is
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L: R: L: R:
- rear
Building height
Bldg Square footage S Q �
%Open Space:
(Lot area minus bldg S M Q
&paved parkingi
# Pf 'Parking spaces \�
# (of Loading Docks
Fill:
_(vol-ume--& location) r s
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: - o APPLICANT's SIGNATURE
NOTE: Issuance of a zo)ning permit does not relieve an applioanra burden to oomply withl,,all
zoning requirements and obtain all required permits from the Board of Health, Cohaervation
Commission, Department of Publio Works and other appliomble permit granting authorit;es.
FILE #
Fi 1 e No.
JON Q jc�,.:,.� 7
ING PERMIT APPLICATION (§10 . 2)
s- LEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: ���� ( �-S� ��`�';�l Telephone:
2. Owner of Property:
Address: Telephone: S-iw (0
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# 7/7 Parcel# District(s):6,/�
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
S. 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 V/ DON'T KNOW YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Y/ 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-1999-1134
APPLICANT/CONTACT PERSON Harlow Builders
ADDRESS/PHONE 336 COLES MEADOW RD (413)586-0465
PROPERTY LOCATION 34 CAROLYN ST
MAP 17A PARCEL 079 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: REPLACE 2 PORCH PIERS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildina Plans Included:
Owner/Statement or License 052460
3 sets of Plans/Plot Plan
T19' OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Ltle 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
;c,Appyroval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission
Signature of Building O, vial 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.
34 CAROLYN ST BP-1999-1134
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A-079 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-1999-1 134
Project# JS-1999-1874
Est.Cost: $600.00
Fee: $20.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Harlow Builders 052460
Lot Size(sq.ft.): 11630.52 Owner: GLASSMAN RICHARD
Zoning URA Applicant: Harlow Builders
AT: 34 CAROLYN ST
Applicant Address: Phone: Insurance:
336 COLES MEADOW RD (413) 586-0465 Workers Compensation
NORTHAMPTON 01060 ISSUED ON.-6125/1999 o:oo:oo
TO PERFORM THE FOLLOWING WORK.-REPLACE 2 PORCH PIERS
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: HOLE S O"r
G -;?F4W
Final: Final:
Rough Frame:
Gas Fire Department Fireplace/Chimney:
Rough: Oil: Insulation: +
Final: Smoke: Final:
r
.zzW ';:.'�N'e.'7```.,(a'}k•' S r'4rn r
THIS PERMIT MAY BE REVOKED BY THE CI OF NORTHAMPTON UPON VIOLL TION OF
ANY OF ITS RULES AND REGULATIONS. 7
Certificate f Occupancy. Sienature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 6/25/1999 0:00:00 $20.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo