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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location i o�L/ 1"s Lot No.
2. Owner's name z3n. � Address c3
3. Builder's name - : Address
Mass.Construction Supervisor's License No. O/�i� 1 Expiration Date X166V
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:-
a J'D
The undersigned certifies that the above statements are we to the best of his, hc,
knowledge and belief.
/ Signature of responsible app,icant
Remarks G `'� oobl2
04K11AMP�t7
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(lipernlittee)
with a principal place of business/residence at:
f � / - ►'�, r � G�/D �� (phone#),,
(streedcity/s dZip)
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) (F.xpirat on 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 Compauy/Pohcy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional shod ifneoe:sary to include infocwafioa pertaining to av ooatmd )
( I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware tfiai whilo homeownct s who employ pasom to do maiatcnance coatnxiioa or repair work on a dwelling of
not more than throe units is which the homeowocr residm or on the grounds appurteawd tb=to are not gcnaaky oomidcrcd to be
employers under the veneer's compensation Act(GL152,ss 1(5)),application by a homeowner for a Uccase or permit may evidenoe the
legal status of an employer under the Worker's Compemation Ace.
I understand that a copy of this staiemeoi may be forwarded to the Deputmcot of Industrial Aocidw&Off oe of Inwrwnoe for the
coverage verification and that failure to seatre coverage under sectioa 25A of MOL 152 can lead to the imposition of criminal Peaaltics
oomistiug of a fine of up to S1,500.00 and/or imprisaarnen#of up to one year and civil pcml6a in the form of a stop Work Order and a '1
aw c(3100.00 a day against me.'
For drp=tmmtal use calY
Permit Number
w Maps# Lot#1
Signature of Lic==VPermittee 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 colunn to be filled in
by the Building Depaztment
l..Cl L1L UctL.Lull: 1 nereoy cerrity that the information contained herein
G is true and accurate to the best of my knowledge.
DATE:a C;2 2 APPLICANT's SIGNATURE OR 4 .
NOTE: lnaus6&oa of a zoning permit does not relieve an applicant's burden to comply Witia all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appiloable permit granting authorities.
FILE it
Existing
Proposed
IKequireci
By Zoning
Lot size
Frontage
Setbacks - frnnt
- side
L: R:
L: R:
- rear
-i-
Building height
Bldg Square footage
%Open Space-
(Lot area minus bldg
&paved parking)
# of -Parking Spaces
# (of Loading Docks
Fill:
Avolume -& location)
l..Cl L1L UctL.Lull: 1 nereoy cerrity that the information contained herein
G is true and accurate to the best of my knowledge.
DATE:a C;2 2 APPLICANT's SIGNATURE OR 4 .
NOTE: lnaus6&oa of a zoning permit does not relieve an applicant's burden to comply Witia all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appiloable permit granting authorities.
FILE it
Fi 1 e No. t
Q, l
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: 7/ /W-O� Telephone: –7
2. Owner of Property: /V2
Address: 1"2 �. Telephone:
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 THE BUILDING DEPARTMENT)
5. 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 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)
324 AUDUBON RD BP-2000-0194
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:05-048 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:REPLACEMENT DOOR BUILDING PERMIT
Permit# BP-2000-0194
Project# JS-2000-0316
Est.Cost: $2350.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: DA Williams 014612
Lot Size(sq.ft.): 3881 19.60 Owner: PARSONS JOHN M&DOROTHY V
Zoning:RR Applicant: DA Williams
AT: 324 AUDUBON RD
Applicant Address: Phone: Insurance:
81 Water St. (413) 586-3139
LEEDS 01053 ISSUED ON:8123/1999 o:oo:oo
TO PERFORM THE FOLLOWING WORK.-REPLACE SLIDING GLASS DOORS W/OUTSWING PATIO
DOORS
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 signature:
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