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11C-029 (3) a O � � m G p O Z M m O Z > cn O \O 1 Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MASS. 9 19 Additions ~• Repair ' APPLICATION FOR PERMIT TO ALTER (� Garage 1. Location cyl— �f Lot No. 2. Owner's name nn Gov Address �t 3. Builder's name KJ_ qty ` , Address Mass.Construction Supervisor's License No. D/ /t Expiration Date l 4r—oa' '510C90 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 13. Siding house 14. Estimated cost:; The undersigned certifies that the above statements are true to the best of his, hc; knowledge and belief. aD. ce ` Signature of responsible appicant Remarks lge)6t-ed- g�HAMP� c e•o�°o.• f �. (rztR laf Nart4aulpf an � B �lasaaclraactta �6 DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT (license&permittee) with a principal place of business/residence at: q <7 (phone#) S/Z (streedcity/sta tdzi p) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees woricing 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 Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additioml sheet ifnecenary to ine}udo infw on pataining to ell ooatrad ) ( I am a sole proprietor and have no one woriang for me. ( ) I am a home owner performing alt the work myself. NOTE:please be aware that while homeowners who employ persons to do mahtM.*+Ax,oortzucdoa or repair work on a dwelling of not more than throe units is which the homeowner resides cc on the grounds apputteas at thereto ace not gcnaalty considered to be employers under w the orker's oompcasatioa Act(GL152,ss l(5))�application Iry a homeowner for a license or permit may evidence the legal status of an employer under the Workeet Compemdion Act I unde stAnd that a copy ofthis tutement may be forwarded to the Dopartnscot of uhutriel Aomdea&Offl-of Imucwce for the coverage verification and that f dwe to secure covetago under sectioa 25A of MOL 152 can lead to the imposition of eriminal penalties comisUn of a fine ofup to S1,500.00 and/or impaisomner3 of up to one ysar and avta pcn Wcs in the form of a Stop Work Order and a find of S100.00 a day against tae. i For dq=bnWW 11e only Permit Number 'V Mao Lot# Signature of Licensee/Permit tce n 5 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 column to be filled in by the Handing 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) # ., f -Parking spaces # of Loading Docks Fill: (vol-ume--& location) 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. DATE: � -_ ' APPLICANT`s SIGNATURE }" NOTE: 1 nce of a zoning permit does not relieve an appiioanVa burden to oomply witlt,,.ptl zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Department of Pubilo Works and other applicable permit granting authorities:.. =` ,, FILE # 0 10999 File ZONING PERMIT APPLICATION (§10 . 2 PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: Address: 7 / "9 a/A"Iephone:_ 2. Owner of Property:_ _ Q�41 '17VA1&-aA— Address: /Z�a all -_�z /1- / ephone: 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain):_ 4. Job Location: Parcel Id: Zoning Map# Parcel# District(s): (TO BE FILLED IN BY THEWILIJING DEPARTMENT) 5. Existing Use of Structure/Property 6. Description of Proposed Use/WorkJProject/Occupation: (Use additional sheets if necessary): ell 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 PermitNadance/Finding ever been issued for/on the site? NO DON'T KNO"Al 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) r File#BP-2000-0142 APPLICANT/CONTACT PERSON DA Williams ADDRESS/PHONE 81 Water St. (413)586-3139 PROPERTY LOCATION 140 FLORENCE ST MAP 11 C PARCEL 029 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT , Fee Paid Building Permit Filled o Fee Paid Typeof Construction: REBUILD EXISTING 8 X 16 DECK W/STEPS&RAIL New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 014612 3 sets of Plans/Plot Plan THE FALLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: pproved 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 ission d Signature bf1luilding 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. 4 r , ,z S t � v 4 tr t Al 4 fir i > 140 FLORENCE Sr BP-2 -0142 GIBS#: COMMONWEALTH OF MASSACHUSETTS `.. MM:,�k-11 C.029 My OF NORTHAMPTON t-061 Permit Building Utter:Non ga M bIl orrenov, fi= BUILDING PERMIT Permit# W-2tQQ-t1142 Project# J;�-�_n Est.CO:$2250 Fee 50. PEMSSION IS HEREB Y GRANTED TO: pnstlass: Contractor: License: .VA(_roan: DA Williams L&Naka.$:j: 96 ,¢,76 Owner: QLQSS J©HN J SHERRI 1\4 -,c AT 1, FL©REND ST Agpl nt Ads vne: , ns ,ce; 81 Water St. (413) 5_60:3I39 LEEDS 01m IS UE0 Q M-811217999 U•00•80 TO PERFOR I THE FOLLfI NM WORK.REBUILD EXISTING 8 X 16 DECK W/STEPS &'RAIL I'tI THIS PAN R IS VISIBLE S Inspector'ofPumhiug Inspectrofwiring" D.PAN Ins pectar of Bu#diags . Underground: Service.; Meter: Footings: Rom: Rough: House# Foundation: Final: FinnI: Rough Frame: y� Gas Dire Department Fireplace/Chimney: Roughs Insulation: Final: umoke: Flush THTS PERMIT iY BE REVQKED BY THE CITY NURT C 'bV'VIOLATION OF ANY OF ITS RULES AND REGULATIONS. NS. a rf• F e e: Recei t No Dat Paid: Check No: Amour#: Building 8/12/1999 0:00:00 $54.00 ' 212 Main Street Phone(413)58" 240,Fax:(413)587-1272 Building Commi' oner nthony Patillo