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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
• Repair
' APPLICATION FOR PERMIT TO ALTER
c Garage
1. Location 6 i k)ed74 44,4 a le -Sq- > Lot No.
2. Owners name ►h M /W Address I lL��,►�7� 14,74o/'Y .SO`
3. Builder's name JAA 01A � Address
Mass.Construction Supervisor's License No. /1 ��'/ Expiration Date
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 �J
12. Type of roof cf t- `, 1-6 d-tT ,a
13. Siding house
14. Estimated cosL-1�CU()OJ
The undersigned certifies that the above statements are true to the best of his.
knowledge and belief.
Signature of responsible appitcant
Remarks
04 tfpTO
�
6 t ? AUG, 2 3 I(Y1f1 :ssschnsctia
_ DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
1, � ,may^'
(licen_seelpermi��ee)
with a principal place of business/residence at:
O SUS(phone#) —d'Y- -�---23 2
(streef/ci app)
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 working on this job:
(Insurance Company) (Policy Number) (Fxpiration Date)
4-am- a sole pro pnet , 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 Compaay/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(anach additioml sheet ifnecessary to include infocsnatioa pertaining to all o atra ofs)
(i4 I am a sole proprietor and have no one working for me. j
( ) I am a home owner performing all the work myself.
NOTE:please be awaro that whilc homcowum who employ persons to do�,im ncr coasructioa at repair work on a dwelling of
not more than throe units is which the homoowoer resides or on the grounds appurtensnt thereto an rot geoetaity ooasid«cd to be
employers under the vmcker's oompe ns4on Act(GL152,ss 1(5)),application by a homeowrir for a Uccuse or permit may evidcnoe the
legs!stabrs of an employer under the Workoes Compomation Ad.
I understand that a copy of this szatemmr may be forwarded to tho Departmrat of I"L';Uial Attideats'Off o0 of Iasuraooe forthe
coverage va-ificatioa and that failure to sour covcrago under section 25A of MGL 152 err lead to the impost -Of-k"-'penalties
oanisting of a floe of uP to 51,300.00 and/or kgxisomnerl of tip to one ytw and civil penalties is the form of a Stop Work Order and a '
fmo 0f3100.00 a day against me.
For use only
/) Permit Number
('
Lot#
MaP
S CY ermitxcc Date
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 —1— to be filled in
by the Building Department
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
&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.
DA'Z'E: 2L}/9 9 APPLICANT's SIGNATURE Gv l
NOTE: Issuanoe of a zoning permit does not relieve an 14pplion nt' urden to oomply wit"'all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appiiooble permit granting authorities.
FILE if
i_.U° AUG 2 3 1999 Fi 1 e No.
N E
r �
PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: ; In Q-A 4'!k'14 w
1
Address: �t1 t,V r ti /13 i" _Telephone: 57
2. Owner of Property: 2M.e rX &V"C N
Address: 1 n�P2t �Lfit Telephone:
3. Status of Applicant: Owner ✓ Contract Purchaser Lessee
Other(explain):
4. Job Location: fa' I l d-
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Des ri ton of Proposed Use/Wor r ject/O cupation: (Use additi nal 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.
r
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 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)
188 NORTH MAPLE ST BP-2000-0191
GIS#: COMMONWEALTH OF MASSACHUSETTS
MaL:Block: 17A-222 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:roofing BUILDING PERMIT
Permit# BP-2000-0191
Project# JS-2000-0311
Est.Cost: $8000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Groin Quinlan Builders 101707
Lot Size(sg.ft.): 17641.80 Owner: BRAMAN HELEN F
Zoning.URB Applicant: Quinlan Builders
AT. 188 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
5 Hillside Dr (413) 585-0949
HADLEY 01035 ISSUED ON:8123/1999 o:oo:oo
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 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 siznature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 8/23/1999 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo