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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 4& 19 Zp0J Additions
• ' APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location Lot No.
2. Owner's name Address -7- r-01 rw a1-na.S 124,1 f3
3. Builder's name �i9 iz sty `/� 5��7' Address /// GaP7X'/2, 57-ACi i. Lam- �1 S
Mass.Construction Supervisor's License No. Expiration Date LV ;,d
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 4 5 vl kla-LT
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are we to the best of his
knowledge and belief.
gnature of responsible app,icani
Remarks *04 do �'LD riIf_
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r a EP ENT OF BUILDMG INSPECTIONS
211 Min Street ' Municipal Building
_-- —^"c 1%� N rthampton, Mass. 01060
DEPT OF BIJV�'gd01tESPE r
COMPENSATION INSURANCE AFFIDAVIT
f/2/2 y J' Y�NT 5c-rt
(IicensuJper'rnittee)
with a principal place of business/residence at:
40 Tr'/L 5T/��� T�_ � �JS, ./yi 4 l OX; (phone#) -55 1- y7sZ�
(st=t/city/sWd2ip)
do hereby certify, under the pains and penalties of pedury, 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) ansurancc Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(artaoh additiomi shoes ifneoessary to uwlu a udbnnaaon perta;aiag to all ooaft*d zs)
I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please ba awue*,A%vWo homeowners who employ pasom to do=k_ =.-,,eeo& Ioa a rspsk work on a dvYdit of
not in,re than duns units in which tbe homeowner resides or on the grounds appurtenant 2haeto art not generally oomidatd to be
employers under the wodcees compcosation Act(GL152m1(5)),applimtion by a homwww fora&Cos*or pamitmay evidence rho
legal stahn*fan employer undw the Wodrds Compawation Act
I uudenund that a copy of this tutemmt may be foswardad to the Dcpwmrcet of Indatrial Aa idmts•OTWO of Insurance for the
coverage vaifiaden and that failure to secure covaW under section 25A of MGL 152 an lead to tbe kTosidott of"=Uml penalties
oomucing of a fine of up to 51,500.00 and/or impcisoamezA of up to one yew sad civil p=atties is the form of a Stop Waft order and a .
fine of 5100.00&.day against tae
For&PUta-a—caly
17 4(�e"Gk> Map# Lot 0
Signature of ermitice
_
. .
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
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
Thin ccl== to be filled In
by the Banding Uepar=�ent
Required I
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
&paced 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.
DATE:_//,�-f/4j el APPLICANT's SIGNATURE j �j y1
NOTE: Issuanoe of a zoning permit does not relieve an appli n urden to oompty Wit" .411l
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission. Department of Publio Works and other applioable permit granting authorities.
FILE #
' a}
Q 20 Ei1e No.
DEFT OF$U! !idG IN
. "IG PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: L19212 y �j
Address: //< a,g T-FA- ST-/ T i-`'�!V--j( Telephone:_ 6-`a y-
2. Owner of Property: i2/G/�.�/�t� G�✓�
Address: -7). Telephone: 67" e'-y22�
3. Status of Applicant: Owner V� Contract Purchaser Lessee
Other(explain):
4. Job Location: 1-"2- ,0=D>' /;Z's,
Parcel Id: Zoning Map#_/;W Parcel# tY Y District(s):_ ,G/ieA.-
(TO BE FILLED IN BY THE BUILDING DEPARTMENT) _em.
5. Existing Use of Structure/Property 5iiy G� p�olryiiLy l��o-'
6. Description of Proposed UseANork/Project/Occupation: (Use additional sheets if necessary):
-6r44,0
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/Vadance/Finding ever been issued for/on the site?
NO DON'T KNOW z _ 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 J 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)
72 FOX FARMS RD BP-2000-0636
GIs#: COMMONWEALTH OF MASSACHUSETTS
owk Map:Block: 17A- 155 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:roofing BUILDING PERMIT
Permit# BP-2000-0636
Project# JS-2000-1145
Est.Cost: $5500.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Larry Yentsch_ 048666
Lot Size(sq.ft.): 19994.04 Owner: COVELL RICHARD B&HELEN R
Zoning.URA Applicant: Larry Yentsch
AT. 72 FOX FARMS RD
Applicant Address: Phone: Insurance:
111 WATER ST (413) 584-4750
LEEDS 01053 ISSUED ON.1/4/00 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
00ft, 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 Sisnature:
Fee Tyne: Receipt No: Date Paid: Check No: Amount:
OPP-
Building 1/4/00 0:00:00 918 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
72 FOX FARMS RD BP-2000-0636
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A. 155 CITY OF NORTHAMPTON
Lot:-o0
Permit: Buiidina
Category:roofing
BUILDING PERMIT
Permit# BP-2000-0636
Project# JS-2000-1145
Est.Cost:$5500.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO.
Const.Class: Contractor: License:
Use Group: Larry Yentsch 048666
Lot Size(ss .ft.): 19994.04 Owner: COVELL RICHARD B&HELEN R
zonina:URA Awlicantr Larry Yentsch
AT. 72 FOX FARMS RD
Applicant Address: Phone: Insurance:
111 WATER ST (413)584-4750
LEEDS 01053 ISSUED ON 114100 0:04:04
TO PERFORM THE FOLLOWING WORK.-STRIP & 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 Framer
Gas Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
3
r
�i: ti.
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLA N OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Si nature:
Fee Ty
pe: Receipt Nos Date Paid: Check No: Amount:
Building 1/4/00 0:00:00 918 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo