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D1'PAR,TMENT OF BUILDITIC INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060 '
WORT{ER'S COMPENSATION INSURANCE + ' AVIT
---�
a FiicensecJpermittee)
with a principal place of business/residence ay.
�Z (phone#) SF"I-
f (stmt/city/stalrJrip)
do hereby certify, under the pains and penalties of penury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees wor'Eng on this job:
Company) / (Policy Number) j (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following workers compensation policies:
(Name of Contractor) (Insurancc 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 Compauy/Policy Number) (Expiration Date)
(attach additioml shod if noocsvey to ix CT infb m3.6on pertaitaag to ell ootradcra)
O I am a sole proprietor and have no one working for me..
( ) I am a home owner performing all the work myself.
NOTE:plenae be awam that whilo homeowom wbo cmpl oy perzow to do m ..e r,wastrvetioa or repair wocic ou a dwelling of
not mora than throo units in which the bomoowucr resides or on tbo grouods appurtcnsnt tbacte ace cot gcoa-ally 000nidacd to be
employes t,Ddef tho wor*ct's compczs4on Act(GL152-"1(5))�apptic&tion by a homeowner for a ticmx or permit may evidcnoe the
Icgal ctahu of an employer under thO Woricces compmsatioo AcL
I understand dirt a copy of tbu crmt--it may bu forwarded to tbo Department of raid Ace;dw&OfSOe Of Imurwoc fortha
coverage vcrMcaiioa and that failurc to too=oovavZo under section 25A of MOL 152 can lad to the imposition of criminal Pcaalba
ooau--i ag of a'f oc of up to S I,500.00 and oc impt-isoomcai of tip too=year and civil praaltics is the form of n Stop W orlc Ocder and a
fmo o(5100.00 a day against mc.
For dep t.—W—Only
j permit Number
/ e✓� 2vfa L°t#.
Signature ofLicc nscc/Pcrmittcc LtiLe
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
ti
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
--- Garage
1. Locations `li �'�- �� / Lot No.
2. Owner's name T�� ✓�� %h Address
3. Builder's name Address An/,?
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration s .r7 N n,A-� -
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:- ,y
x_.42 c
The undersigned certifies that the above statcmcnts are we to the best of his,
knowledg and belief.
Signature of responsible appaicant
Remarks
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 columm to be filled in
by the Building D]partment
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 parkingi
# of -Parking Spaces
ht 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.
—LATE: j APPLICANT's SIGNATURE`
NOTE: Issuanoa of a zoning permit does not relieve an applioants burden to oompty With 4111
zoning requirements and obtain all required permits from the Board of Health. Conservtation
Commisslon. Department of Publio Works and other applicable permit granting authorities,
FILE #
C�CIt
APR 5
File No. �
M . -- ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: /x,-,
Address: Telephone.
_ d
2. Owner of Property: < % ,�
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# Parcel# J7ZX District(s):
(TO BE FILLED IN BY THE BUIL1bIWG DEPARTMENT)
5. Existing Use of Structure/Property fie62
6. Description of Proposed Use/Work/Project/Occupabon: (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 vl 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-1999-0825
APPLICANT/CONTACT PERSON Thomas Gross
ADDRESS/PHONE 237 Plumtree Rd (413)665-8235
PROPERTY LOCATION 91 GROVE ST
MAP 38 PARCEL 048 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildina Permit Filled out
Fee Paid
T_ypeof Construction: REMOVE CHIMNEY
New Construction
Non Structural interior renovations
Addition to Existinp,
Accessory Structure
Building Plans Included:
Owner/Statement or License 059093
3 sets of Plans/Plot Plan
T THE/LLOWING 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 Commis '
Signature of Bui mg 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.
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91 OX0 T.Mo* T SIM-= 81'-1'909-0825
U-048, CITY OF NORTHAWTON
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111ILDING PERMIT
PEMSSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Thomas Gross 059(193
L `A�" ., fir.349.QQ QVW Nt?a'rrMMMN SIAM UQSEUAL
Si = m I%art Ths►mas Gross
GATE SI SHELTER _
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4 -823
SUfi+1t3�Rl�iNE� : 01375 Ii'IE�t�:�f&✓Yl►99 fl:UUrf1�1
TO A . FOLL(J WNG WO ` ►»REMt1VE CHIMNEY
Q S ET
ter of p tetar of wil alp:w. Inspect of BniidiaV
Untsrgoun : Setce: Meter:
Footings:
Rengh:' . Reins Ronne# Fonadattc►st:
Fitw'l: Fi�t�:
Rough Frames
Gas Fire Ttenartment Fireptaceichim►ey
Rofgh: InsWaRon:
THIS PERMIT-MAY RI;REVOKED BY THE CITY U NOR OF
ANY OF 1 RUL E R, GtA►1'I(JNS.
t
Rate IPAW;
Building 4/8/1999 11:00:00
212 Nbin Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner Anthony Patillo