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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 7Z-/ Alterations
ZI
NORTHAMPTON, MASS. 19�! Additions
APPLICATION FOR P RMIT TO ALTER Repair
a
7 Al- F / Garage
1. Location / lG— m.41LI f19a (1 Lot No.
2. Owner's name /� 7 U ( � A4 Address 112— /��. / '( �l
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration ptj-::- kD X aC
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:- 12tl g".
The undersigned certifies that the above statcrtt�nts are true to the
knowledge and ief.
ig turc of re rtsi a app i
Remarks / d
�04ttt/Vlp�0� l l
B8 ,Ain�encllurcllc
ur r'c, DEPARTMENT OF DUILDING INSPECTIONS
INSP ( TR 212 Mnin Strcct ' Municipal Building '
6 1 � Northampton, Mass. OlOGO
SEP 1 d pqqq
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DEPT OF BUILFl,:
Fs
m _ DEP;kTMENT OF BUILDING INSPECTIONS
DEFT g SUgL " EtdSPECTIlN�212 Main Street ' Municipal Building '
NORTHAMPRoLl " Northampton, Macs.• 01060
V '+,
WORKER'S COIITENSATION INSURANCE AFMAVTT
(licenscrlpermittee)
with a principal place of business/residence at:
112— M,4 (phone#) 1, °
(stn t/ci ty/stalrJri p)
do hereby certify, under the pains and penalties of pegLify, that:
( ) T am an employer providing the following worker's compensation coverage for my
employees wor sing on this job:
,(lnsurance Company) (Policy Number) (Expiration Date)
(V�/, am"a sole proprietor, general contractor o omeowner circle one and have hired
r )
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 Coniractor) (Insurance Comparry/PoUcy Number) (Ft-piration Dale)
(Name of Contractor) (Insurance Compaay/PoUcy Number) (Expiration Date)
(artadi addi$easl sheet ifnocc=ary to inchsdo information pertnimng to all co n)
( ) I am a sole proprietor and have no one working for me.
K I am a home owner performing all the work myself.
NOTE:plcaao be awes that whilo bomco%mcn abo a mpicy pcnom to do m••f,-�coosruc600•or repair work on a d-11ing of
not more than throe unity is whscit the bomoowncr residn or on tlae grounds appu uaant tbento arc not gmcrally coasidcrcd to be
employes under tbo wmkc s oomp=ssation Act(GL152,a l(5)),application by a bomcowncr fo:r a 6ccox or pamii may evidence tbo
legal stama ofan employer under the Wackeea Compec a"Act
I understiad that a copy of this rb lemrai may be forwarded to the Depert+aeoa of 1odu:trid Aoadm&Oboe of Inxuaooe fa the
0DV=N a vrrificstioo and that failure to secure coveago under soctioa 25A of MOL 157 can lad to tbd impoa-of aimind penalties
oomistina of a-fine bf upt to 51.S 00 andlor imprison of tip to one year and civil p=LWes is 6o f«m of a Slop Work Older and a
fine oC5100.00 a day against ttsG
c
y For dvfftiaodal rise ody
Pcrm#Number
=x. . .. Mao Lair
-- Signature. . .. C=aittcq• ._.. ,.c-••r��:Y;::-ez _;_. - -. . ... . .
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 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 corm to be filled in
by the Band==' 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 minus bldg
&paved parking)
# of -Parking spaces
f of Loading Docks
Fill:
{vol-ume--& location)
13 . Certification: I hereby certify that the information contain d herein
is true and accurate to the best of my knowle
DATE: J APPLICANT's SIGNATURE
NOTE: Iss6(an44 of a zoning permit does not relieve an applicant rden comply witll�all
zoning requirements and obtain all required permits from the 13..Ad of Health, Conservation
Commission, Department of Publio Works and other applloable permit granting authorities.
FILE #
rSEP 1 4 egg
DE >3 pjt 44G 1tq PECTIp File No. C% RTHAMPT(;hl, k Ctp6QH5
ZONING PERMIT APPLICATION (§10 . 2)
PLE.A.SE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: v
Address: 112— /v j kf Telephone:
2. Owner of Property:_� �
Address: Telephone: � (v
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): 9
4. Job Location: 11,2— /L -
Parcel Id: Zoning Map# � Parcel# o? District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed UseMlork/Projec ccupation: (Use additional sheets if necessary):
�- w�d
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the followi/questi ns may be obta ined by checking with the Building Dept or Planning Department Files.
8. Has a Speciaadance/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 ocument#
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)
F " 4
112 NORTH MAIN ST BP-2000-0271
GIS#: COMMONWEALTH OF MASSACHUSETTS
MapBlock: 17C-266 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:roofing BUILDING PERMIT
Permit# BP-2000-0271
Project# JS-2000-0441
Est.Cost: $2000.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group:
Lot Size(sa.ft.): 5052.96 Owner: GIARDINA ANTHONY&EILEEN
zoning:URB Applicant._
AT. 112 NORTH MAIN ST
Applicant Address: Phone: Insurance:
ISSUED ON.o9/14/1999 o:oo:oo
TO PERFORM THE FOLLOWING WORK.-STRIP, PLY & 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 Sienature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 09/14/1999 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo