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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location / �'�. �► 5 f ���«-+ Lot No.
2. Owner's name r l et 0, Address 1- 3 /,��4 ti S /- /G e-,c
3. Builder's name Ke, 64 L Le Address 3 r`i R-4,/-c
Mass.Construction Supervisor's License No. y 4,o K: 2C-) Expiration Date
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
13. Siding house
14. Estimated cosc-
vvv.
The undersigned certifies that the above statcmcnts are we to the best of his
knowledge and belief.
Signature of responsible app,icanl
kemarks ttQ 011 cc e- vet erg
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B � ' '' �lassacknsctla
3 01 9 DEPARTMENT OF BUILDING INSPECTIONS
.,.
212 Main Street ' Municipal Building
Northampton, Mass. 01060 '
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(hcenscrlpeTmitzee}
with a principal place of business/residence at:
3 r 1 s' A k, 4.e-,i (phone#) Sy 9 s_i.s r
(street/city/stale/up)
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/Poticy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contactor) (Insurance Company/Policy Number) (Expiration Date)
(attach ad"00tal shed ifnecesmy to i0cWe information pertaining to an ooutmc rs)
(--J/I 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 while homeowners who employ pasom to do mam eaaace,court uWon cr=pairwork ou a dwelling of
not mere than thteb units is which the homeowner raids of oa the grounds appurtenant thereto are twt Swan ty eomidered to be
employers cadet the wo wr s oompmsation Act(G1.152.ss 1(5)).application by a homeownis fora Betas ere permit may evidence rho
I"d stalm of an employer utsdw the Wert s Compemati«s AcL
I understand that a copy of this statement may be forwarded to tbo Depastmma of Indtutriai Aoddmt{Offioe of Insrusaw for dw
coverage verification and that failure to secure coverage under section 25A of MOL 152 can load to the'imposition of criminal peaddes
oomisting of a foe of up to S1,500.00 saNcir itnprisoanxut of up to one year and civil petaWes is the farm of a Stop Work Order and a
fmo of 3100.00 a day against tnc
For dVwtwwtd use only
Permit Number
2-34 -19 Map# Lot#
Sipature of Licensedpermittce
r
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.
Thin comma to be filled in
by the 8ttilding Department
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 parking%
# of -Parking spaces
#t of Loading Docks
Fill:
vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DA'Z'E: /?. 7o- i`f APPLICANT's SIGNATURE_
NOTE: l"uanoe of a zoning permit does not relieve an appiioA nt's burden to oomply Witty-all
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission. Department of Publio Works and other applioable permit granting authorities.
FILE #
i � l t
3 0 1999
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: 3 `4 R"1c �� /��J���� � Telephone:
2. Owner of Property: -1 "��• "
Address: +' 3 1��V y s Telephone: t'-6-Y
2
3. Status of Applicant: Owner _(/ Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# ?D Parcel# District(s):
(f0 BE FILLED IN BY THE BUILDING DEPARTME T)
5. Existing Use of Structure/Property C)WAC�
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
JJ,
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/Vadance/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 j�_ 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)
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3 HIGH ST BP-2000-0627
GIS#: COMMONWEALTH OF MASSACHUSETTS
✓Iap:Btock: 17D-043 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:windows replaced BUILDING PERMIT
Permit# BP-2000-0627
Project# JS-2000-1121
Est.Cost:$5000.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO.
Const.Class: Contractor: License:
Use Group: Gale Home Improvement 060020
Lot Size(sa.ft:): 5183.64 Owner: MARTIN JOHN K
Zoning:URB Applicant: Gale Home Improvement
AT.• 3 HIGH ST
Applicant Address: Phone: Insurance:
319 Pine St (413)549-5951
AMHERST 01002 ISSUED ON.12130199 0.00:00
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:
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 signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 12/30/99 0:00:00 848 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo