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17C-307 (2) � .0 0 70 'p � o 3 OZm ao ?7 Z a _ ` o Z .' o -� -� X Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MASS. 1-2� E��19�� Additions APPLICa ATION FOR PERMIT TO ALTER Repair / Garage I. Location Li? LA,k G S I' C(�r�� e m Lot No. 2. Owner's name Ed-14-0 ABC oar- 1pi Address '/,2' ke 5 7" Fto-ir i,-Q- 3. Builder's name Wrs ;ee-i 12A S J;,,, n e-"-4 � Address 6 3 Fas'7' S% /�r f'no Mass.Construction Supervisor's License No. H CA f b ti L 3,1 Expiration Date�6610 0 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 n 13. Siding house�S / c�roylc? c e vn e•.-, t v r"n 70 14. Estimated cosL- �ti The undersigned certifies that the above statements are we to the best of his, h knowledge belief. Signaiure of responsible app,icanl Remarks 0 0 °. Clif r of #I�ttnt rtott 4 $ 6 �lasaacbnsctis DEPARTMENT OF BUILDWG INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT L I 0'az2� (licens�eJpermittee} with a principal place of business/residence at: f4a—, M,, (phone#) 5 C 'f � 7 ( city/sta&z:ip) 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) (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) (attach additioml sheet if neocaary to include information pertaining to all oodmdom) ( 16rI 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 that whilo homeowners who employ pc=m to do maim'�wustru i oa or repair work on a dwelling of not more than throe uaitt in wbieh the bomeowncr resides or oa the grounds VWdenant tbeteto are not geaeraily oDnndcrcd to be employers under the vmr1ce's compensation Act(GL152,m 1(5)),application by a homeowner for a licaue or permit may cvidcnoe tho legal status of an employer under the Worker's Compensation A L I understand that a copy of this ualeaseat maybe forwarded to the Deparww is of Indrts4ial Aecidearb'offioe of Imrnwnoo for the coverage verification and tbat failure to socure coverage under section 25A of MGL 152 can iced to the im positioa of criminal prntaltioa consisting of a fine of up to$1,500.00 at&OC imprisourncrit of up to one year and civil penalties in the form of a Stop Work order and a firm of 5100.00 a day against me. For dgmtmeotal use oalY Permit Number /$^ j Map# Tat# ' grab=of Li ermittee 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 c01n= to be filled in by the Building Department I Required Existing Proposed By Zoning Lot size Frontage Setbacks - frnnt - side L: R: L: R: - rear Building height Bldg Square footage %Open Space: (Lot area minus bldg &paved parki-ng) # of -Parking spaces # '6f Loading Docks Fill: -(volume--& location) 13 . Certification: I hereby certify that the information contained herein r� is true and accurate to the best of my know dge.. DATE: :2 f5` APPLICANT's SIGNATURE NOTE: lssuan a of a zoning permit does not relieve an appiioant's burden to oom zoning IY With 4111 g requiramants and obtain all required permits from the Board of Health. Conservation Commission, Department of Publio Works and other applioabla permit granting authorities. FILE # Fi 1 e No. ZONING PERMIT APPLICATION (§10 . 2 PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: S h � �95` c-��PZ• � �'�r�- Address: 3 S'7- r9- �j 0er'9/ `QN Telephone: 5E'Ir 2 Z '7 2. Owner of Property: 4fd 4>"t c� G / r Address: L _ �r �ticr nc /-y. Telephone: $ C/ 71 S' 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): 4. Job Location: f,f $ L a. S c -r c Parcel Id: Zoning Map# Parcel# District(s): (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5, Existing Use of Structure/Property d604'e rh" 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): = JQ /a c e 17-7-Orn e•� to j'E2 q/0- 1 c✓S 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) 48 LAKE ST BP-1999-0581 GIs#: '89&, Map: COMMONWEALTH OF MASSACHUSETTS - --- Block: CITY OF NORTHAMPTON 'Lot: 001 Permit Building - Category: windows replaced BUILDING PERMIT (Permit# - BP-1999-0581 Project# JS-1999-0710 Est. Cost: $1,600.00 Fee: _ $20.00 _ PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Western Mass Siding& Roofing HIC- 105630 (Lot Size(sq. ft) 12806.64 - Owner: Western Mass Siding&Roofing (Zoning URB Applicant: Western Mass Siding&Roofing Units Gained: 10 — - -__- AT. 48 LAKE ST (Units Lost: 10 ISSUED ON: 15-Dec-1998 EXPIRES ON: 15-Jun-1999 TO PERFORM THE FOLLOWING WORK: INSTALL REPLACEMENT WINDOWS 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: Fireplace/Chimney: Gas Fire Department Board of Health Insulation: Rough: Oil: Final: Final: Smoke: Treasury: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: replacement windows REC-1999-001598 15-Dec-98 2419 $20.00 212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272 GeoTMS©1998 Des Lauriers&Associates,Inc.