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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No._ Alterations
NORTHAMPTON, MASS. �� —Z� V 19 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location Z HA'1 LbW 1? 4--D LZ Td5 AAA , d t b 5 3 Lot No.
2. Owner's name CrC�P=L OIJ 'a kl�� Address
3. Buildei s name n
`St 2£t� -Y t C V Address
Mass.Construction Supervisor's License No. C-9?7 0 q63 I Expiration Date 6 —0,5" Z–.-
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 roof0N �1 ! ' f L
13. Siding house
14. Estimated cost
The undersigned certifies that the bo e s emcnts are we to the best of his,
knowledge Cf.
Sig aturt j respo-si t .-cant
Remarks
✓�e-Vo'rrhiaoow��c °����QDB(jdt�.� '
k • BOARD OF BUILDING REGULATIONS
a License: CONSTRUCTION SUPERVISOR
Number: CS 074031
Birthdate: 06/25/1966 i
Expires:06/25/2002 Tr.no: 74031 f
Restricted To: 00
JEFFREY S PECK
167 E BUCKLAND RD ( .., r, �°/�✓'"�
SHELBURNE FALLS, MA 01370 Administrator
4JiSt�,•.C.•.0�..... ,,,.�.c. .C.> .....,t4.a. .:,r....,..:..... .. .::,:,.. .-.,..;. ..., .., , ........v ...„. ,<. ,w...., ... ....� . ..,. ., r ..,. .irv.
� � y
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MR.
�'i' 2 R gxtR a# 'Wart4a pion z
a � °. � �lassacpnsrtts
EP OF PUJ[
DEPARTMENT OF BUILDWG INSPECTIONS
212 Main Street a Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
PACK
(li pern1iu=)
with a principal place of business/residence at:
/J.�_�-9�.�o IUD (phone#,)
(streeucity/stawzip)
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) (Expiration Dale)
( ) 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)
(aaach additioml stets if neoessuy to include inform don pereaiaing to an ooatn a )
I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:pleas be aware that while homeowners who employ pawns to do maintenance,oomtnx don or repair work on a dwelling of
not more tban these units is which the homeowner re ides or oo the grounds appuutenwA tba do are not generally comWemd to be
employers Under the twrkeez compensation Ad(GL152ts 1(5)),application by a homeowner for a license or permd may evidaooe the
legal status of an employer under the Wortrees Compensation Ad.
I understand that a copy of this ctatcmmt may be forwarded to the Departmeos of Indaitrial A=dm&Office of Im RInoe for the
coverage verification and that failure to saute coverage under soction 25A of MGL 152 can lead to the imposition of au=d penalties
oomisting of a fine of up to S1,500.00 and/or irmprisonmat of up to am year and civil pcn&Wcs in the form of it Stop W%k Order and a
fine of 5100.00 a day aping me.
For departmental use only
Permit Number
O'Z 5-"Y hfap# Lot#
siPatUt of Lic=sePJPermittee
�IIIM.sitrr.'
10. Do any signs ebst on the property? YES NO .4;
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:
I1. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This eolumm to be f%Zled in
by the Building 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 minas bldg
&paved parkingi
# of -Parking Spaces
f of Loading Docks
Fill:
(volume--& 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: issuance of as zoning permit does not relieve an appnoanYs b den to comply wlt47,pn
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 #
';
OCT 2 61999
"Vol OF BUILD't��1
File 1 e No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRI5;N,.Ty ALL INFORMATION
1. Name of Applicant: )&FEKI`r, 5. ��'"
Address: Z . 15 cj� Telephone: If/3 -62-, -8 'Y
z5H144_-,6cAP-kt f
2. Owner of Property: r_ULDC1� 611/k p
Address: 59 Z R Q Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: J� '2 /�
Parcel Id: Zoning Map# (p Parcel# District(s): Stlet
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property 2_-L /5 -
6. Descriptiorr,,�� 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 KNOItir�_ 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)
File#BP-2000-0444
APPLICANT/CONTACT PERSON JEFFREY PECK
ADDRESS/PHONE 167 E.BUCKLAND RD (413)625-8438
PROPERTY LOCATION 582 HAYDENVILLE RD
MAP 06 PARCEL 004 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled o t
Fee Paid
Typeof Construction: REPLACE FLOOR STRUCTURE REPLACE EXTERIOR DOOR&WINDOW.ADD
WALL COVERING&FRAME IN CLOSET
New Construction
Non Structural interior renovations
Addition to Existing -
Accessory Structure
Building Plans Included:
Owner/Statement or License 074031
3 sets of Plans/Plot Plan
TE[KOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved 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 Commissio
.tom
Signature of Bui ding 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.
5 82 14AYDENVILLE RD BP-2000-0444
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 06-004 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-2000-0444
Project# JS-2000-0770
Est.Cost: $11000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JEFFREY PECK 074031
Lot Size(sq. ft.): 32800.68 Owner: SHAW GORDON
zoning: SR Applicant: JEFFREY PECK
AT. 582 HAYDENVILLE RD
Applicant Address: Phone: Insurance:
167 E. BUCKLAND RD (413) 625-8438
SHELBURNE FALLS 01370 ISSUED ON:1112199 0:00:00
TO PERFORM THE FOLLOWING WORK.REPLACE FLOOR STRUCTURE, REPLACE
EXTERIOR DOOR & WINDOW, ADD WALL COVERING & FRAME IN CLOSET
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 si nature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 11/2/99 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo