17A-173 (8) > o
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. y �� �f Alterations
NORTHAMPTON, MASS. Additions
' APPLICATION FOR PERMIT TO ALTER Repair
rr II Garage
1. Location Lot No.
2. Owner's name d M edI-'S.S � 13�� �'/.�/ Address Vib 0V,--1E si-
3. Builder's name :rL%(+>-j 4, Sig i Address(6
Mass.Construction Supervisor's License No._ a ( 7 O*S 5 Expiration Date Z _ Z ,Y`0 L
4. Addition
5. AlterationL` [51�
6. New Porch
7. 1s 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 we to the best of his, f
knowledge and belief.
ignature of responsible app,icant
Remarks
O O
s� "fs CriN of 'Nart1jamptail
� B f,'�a3axrhnsrtts
m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building 'a
u,$` Northampton, Mass. 01060 J`y
WORT ER'S COMPENSATION INSURANCE AFFIDAVIT
EB 9 `?000
(Iicensec/permitter)
with a"principal place of business/residence at:
e�` cy o ' rj
f LJ 1 tq 7 0 (phone#) _
(str�f/ci ty/statrJzi p)
do hereby certify, under the pains and penalties of pegury, that:
(� I am an employer providing the following workers compensation coverage for my
employees worming on t1us job.
(Insurance Company) (Polio 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 following worker's compensation policies:
(Name of Contractor) (Insurance CompaM/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance. Compauy,Policy Number) (Expirauon Date)
(Name of Contractor) (Inairancc Company/Pokcy Numbe,) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional short ifnocussry to include infvrma2ion pat*zinc to aii ocertradors)
( ) I am a sole proprietor and have no one worlang for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that whilo homcowncn who crploy persona to do�gymi nce consrnu on or repair work on a dwelling of
not more than throe units is winch the homeow=resides or on the grounds appu rtcnaut thereto are not grnerally oomidcrcd to be
employrrs under the worker's oocapcnsation Act(GL152,s1(5)�application by a homeowner for a license of P-Mit may evidence the
legal etahu of an employer under the Workzez Compeoneion Ad
I understand that a copy of this asicmmt may be forwarded to tho Dcperinxut of 1,&dial Arxi Offioe of Insurmce for the
ooverago vmfiestioa and that failure to&Darr=cow-mV under section 25A of MOL 152 ran lead to the imposition of crIMM31 Penalties
comisting of a fine of up to S1,500.00 and/-imprisonnuai of up to one year and civil penalties is the form of a Stop Work Order and a
fine of S 100.00 a day agninsl trsw
For depsrtmr�il use Doty —
/ Permit Number
iv42p4 Lot#
Si of Licensee/Permittee e _ _
I
4
i
M .
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 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 aozW= to be fizzed in
by the 8ai2d=g Department
Required 1
Existing Proposed By Zoning
Lot size
Frontage
Setbacks --fmnt
- 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 contained herein
is true and accurate to the best of my knowledge. ^
D2 E: �- i APPLICANT's SIGNATURE
NOTE: issunnoe of a zoning permit does not relieve an p lioanrs en to oom wit -
zoning requirements and obtain all required PIY . v all
q permits fro he Board of Health. Conservation
Commisslon. Department of Publio Works and other appli bla permit granting authoritios.
FILE if
FEB 9 2000 4�. �-7
File No. /6l
• EC�ptht�5
PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: J c(fii� �• `z < �.�s/ct
Address: l(� �c-Jf Gl,k� ST. 4` jD Telephone: `� 7 `;c y
2. Owner of Property:- 1 _ '
Address: 4c-> 4 tJC Telephone: 57 �� S 3
3. Status of Applicant: Owner Contract Purchaser Lessee
_1�Otheerr(explain): / C
4. Job Location: ( C, 1-�w47 e
Parcel Id: Zoning Map#/ Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property � (3(D c-�5�E-
6. Description of Proposed UseNllork/Project/Occupabon: (Use additional sheets if necessary):
7. Attached Plans: Sketch Plan X- 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/Vadance/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 X 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-2000-0701
APPLICANT/CONTACT PERSON John Zieminski
ADDRESS/PHONE 16 Dwight St (413)247-9014
PROPERTY LOCATION 40 HOWES ST
MAP 17A PARCEL 173 ZONE URB
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: BATHROOM RENOVATION&ADD WINDOW
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 017889
3 sets of Plans/Plot Plan
THE OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presentedibased 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 C ission
� 2C7e�c�
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.
40 HOWES ST BP-2000-0701
CIS#: COMMONWEALTH OF MASSACHUSETTS
la :Block: 17A- 173 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Cateeorv: renovation BUILDING PERMIT
Permit# BP-2000-0701
Project# JS-2000-1302
Est. Cost: $10000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: John Zieminski 017889
Lot Size(sq. ft.): 14984.64 Owner: BASSETT THOMAS A& BEVERLY A S
Zoning: URB Applicant: John Zieminski
AT: 40 HOWES ST
Applicant Address: Phone: Insurance:
16 Dwight St (413) 247-9014 Workers
Compensation
HATFIELDMA01038 ISSUED ON.2/10/00 0:00:00
TO PERFORM THE FOLLOWING WORK.BATHROOM RENOVATION & ADD WINDOW
-POST THIS CARD SO IT IS VISIBLE FROM THE STREET
aspector 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:
3uilding 2/10/00 0:00:00 3559 $50.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Building Commissioner-Anthony Patillo
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40 HOWES ST , BP-2000-0701
GIs#: COMMONWEALTH OF MASSACHV ETTS
Ma
p:Block: 17A- 173 CITY OF NORTHAMPTON
l ot:-00 i
Permit: Building
Cate o :renovation BUILDING- PE IT
Permit# BP-2000-0701
Proiect# JS-2000-1302
Est.Cost:$10000.00
Fee: $50.00 PE"IS"IONIS THEREBY GRANTED tO.
Const.Class: Contractor: License;
Use Group: John`Zierninski 01709
dot Size(sq.ft.): 14984.64
Owner: BASSEj11ffl0M S A&BEVERLY A S
Zoning:URB ADVli+cttttt: .1Q�1 i 2r�3i
4 46 HQyIj�B'Sfi
A,pnlieant Address: Ins rats
lb Dwight St `41 241-9Q 14
Compensation
HATFIELQMA0103$ I O .2
TO PERFORM THE FOLLOWING 0000'kr-BROOM RENOVAT10N &ADS WINDOW
POST THIS CARD SO IT iS E 0.01A,
Inspector of Plumbing Inspector orwit Inspector ?
Underground Service; bar:
Footings:
Rough:0 1k`a/ ®a t3 Raugh; CL`t4. Rouse# Foundation;
Final:1604160 AV.3 Final /
Rough Frame: d�
Gas Fire Department Fireplace/Chimney:
Final, ; ;
OF
SIN
4 AM
I,
« f d i
building V10I00 0 0(f:041' 3539SO,OQ'
212 Main Street,Phone(413)587-1240,Fax:(413)587.1272
Building Commissioner-Anthony Patillo