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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. q/�� 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location �"�` CYO �- Lot No.
2. Owner's name yEr�► rt, a ►, Address >>- Cgu-MI,
3. Builder's name krrw �� C L Address `7 E-I iv►L - S�'r �f
Mass.Construction Supervisor' License No. Z� Expiration Date_ Z
4. Addition
5. Alteration
6. New Porch .�-
7. Is existing building to be demolished? N
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:- y The undersigned cert ifies hove statements are we to the best of his, her
knowledge and belie
Signature of responsible appocant
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m \ DEPARTMENT OP BUILDING INSPECT IONS r
212 Main Street Municipal Building ',o
Northampton, Mass. 01060
WORKER'S CONMENSATION MSURANCE AITEDAVIT
(keens &permittce)
with a principal place of business/residence at:
5�— �
strrHt/ci /siatrla
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 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) ( nsuranc-e Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Folic,-Number) (E�,pim6on Date)
(Name of Contractor) (laa ance,Compai y/Policy Numhe.r) (Bxpyration Date)
(Nam Contractor) (Insurance Comparry/Policy Number) (Expiration Date)
(attadl octal duct ifneccssuy to include mfminstioa per&=_ug to all wcrtrnttors)
( I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:plisse be aware that whilo hcmcoxncra who employ perions to dp ma aje n;corr3ir _or repair work on a dwelling of
not morn than throe units in which the homoowucr nzidc3 of oo the grounds appurtenant ih=w a=no(geaemily coasidercd to be
artployaa under the worker`s compcasatioa Act(GL 152,-5 1(5))�application by a homcown cr for a ticcase or pctmit may evidence the
legll status of an employer under the Worictv'a Compomatiou Ad
I understand that a copy of this ctatcmmt may be for-%%x od to the Dopxi to cd of Iadu,tial Amides Oihoo of Iusuranco for the
covemgc verification and that failure to somm ccvangv under section 25 A of MOIL 152 can lead to the itrzpositioa of criminal penalliea
consisting of a fmc of up to S1,500.00 and/or inpr isomncot of tip to cm year and civil prnsitics in the form of a Stop Worst Order and a
fmo ne5100.00 a day against we
For dgmta--=W use only
Permit Number
Map# LoO;#
SiVaaftfi of Liccnsc&Pcrnaittee
10. Do any signs e b t 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 aolw= to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks r '
- side L: /j'- R: L:L_R:�
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&Paved Parking!
# of -Parking Spaces
t of Loading Docks
Fill:
(vo1-ume--& location)
13 . Certification: I hereby certify that the inform t_ion contained herein
is true and accurate to the best of my knowle ge.
DATE: �� d APPLICANT's SIGNATURE
NOTE: lanuan ® t a zoning permit does not relieve an applioant's burden to oomply with .�Il
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission, Department of Publio Works and other applicable permit granting authorities.
FILE #
SEP 17 098 Rp " qq 3611
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
T S �
�?
1. Name of Applicant:
Address: Nd 1(7) Telephone: 0 (�
2. Owner of Property: �7. �_ ����YWA-� 7
Address: ; ;, �ff�.. f f? �T�--,4elephone: Z
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: C6 CA' '1
Parcel Id: Zoning Map# Parcel# 7,-_ District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
<711 P
5. Existing Use of Structure/Property
J
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
-CLl�e:l r ^
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 Pe itNadance/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 D ument#
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-1999-0309
APPLICANT/CONTACT PERSON Gerry Shattuck
ADDRESS/PHONE 40 Munroe St (413)584-6265
PROPERTY LOCATION 8 COSMIAN AVE
MAP 17C PARCEL 275 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT f
Fee Paid
Building Permit Filled o
Fee Paid
T_v_n_e of Construction:
New Construction `
Non Structural interior renovations
Addition to Existing
Accessojy Structure
Building Plans Included:
Owner/Occupant Statement or License#
3 sets of Plans/Plot Plan
THE�P&LOWING 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 Co ission
t� CJ
Signature of Building Offl6ial 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.
Department: Reference No.- BP-1999-0309
Building, Electrical & Mechanical Permits
Fee Type: Receipt No:
Non structural interior renovations
REC-1999-000770
.........................................................................................
PaidBy: ........................•••...........
Gerry Shattuck Paid in Full On:
............. Thu Sep 17 1.998
ReceivedBy:.........•............**•..................••........ ........ ......................................
Check No:
Linda Lapointe
1432
......................................
DEPARTMENT'S COPY Amount: $40.00
...........................
DEPARTMENT FILE COPY 8 COSMIAN AVE
CITY OF NORTHAMPTON
BUILDING PERMIT
Owner's pulling their own permits or dealing with unregistered contractors for applicable work do
not have access to Guaranty Fund(MGL 142A)
Issued: Permit No: Inspector: Tracking No.: Fee:
BP-1999-0309 $40.00
GIS #: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
1873 17C 275 001 8 COSMIAN AVE URB 10193.04
Contractor: License Type: Insurance:
Gerry Shattuck CSL
Address: License No.: Insurance No.:
40 Munroe St 058422
City: State: Zip Code: Phone:
NORTHAMPTON MA 01060 (413) 584-6265
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0637 Non structural interior renovati $4,200.00
Description of Work:
REBUILD PORCH FLOOR,POSTS
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: