31D-142 BANK (14) a
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. CC��►►((�� Alterations
NORTHAMPTON, MASS. T/G 3 19f 1 Additions
Repair
APPLICATION FOR PERMIT TO ALTER
.J Garage
1. Location Z�J�/__,�ff�/V cS� Lot No.
2. Owners name th e.S F �`f� i Address /`7� /n UAI S t.
3. Builder's name t G i G y—L 75,, 4 Yl 3 Address l k 3 J-i,3 s e�1 R cJ W .4wt-r h:-1D IW t4 .
Mass.Construction Supervisor's License No. 3�l Expiration Date��3 o2lXJ/
4. Addition L
5. Alteration
6. New Porch
7. Is existing building to be demolished? 1Vd
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:- ,#/S 0V a
The undersigned certifies that the above statemcnts are we to the best of his
knowledge and belief.
r ignaturt resportsiblt app�icant
Remarks
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FT(��X11:^ F„ ;DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
w. Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE Ar,MAVIT
(li ce nscr/permi ttee)
with a principal place of business/resideace at:
//3 L NSccs t2D. , 1„1• k+Y4TFTZe.11__(phonet#)V/Y 21V?
> (strc--tJcity/statc/zip)
do hereby certify, under the pains and penalties of perjtuy, that-
( ) f am an employer providing the following worker's compensation coverage for my
employees working on this job:
TrzAvEe-cas RNs. Co. U - 9 7s-/777TgD$ y Iti5ti
(Ins�ce Company) (Policy Number) (Expirati'on Date)
( ) I am �bFe propne eneral contracto r homeowner(circle one) and have hired
the contractors listed below w�o ve e following worker's compensation policies:
GLA-Ss A•LIA.. Wil& �40b 414-01 19000 2006
(Name of Contractor) (Lasurancc Company/Policy Numbcr) (Ex.piration Date)
(Name of Contractor) 0iisurancz- Company/Poticy Number) (Ex-pimtioa Date)
(Name of Contractor) (Insur'an(-- C,ompan.y/Policy Number) (Expiration Date)
(Name of Contractor) (Lnsumo,e Company/Policy Number) (Expiration Date)
(tuuh addit—114cct 11`13—miry to melt&mfvnnxboa peri miog to ell coofraetors)
( ) f ani a sole proprietor and have no one working for me..
( } Z am a home owner performing all the work myself.
NOTE.picaac be aware that whilo hoar_otimcn wto employ perja w do ms.ilj�oowtr u oa ar repair work on a dwelling of
not naoto than throo cruets in which the bomoowucr midn or oa tho Vviads apptutcaxnt tharto arc not Ccacrally cocai6c and to be
employers under tbo worka''i oompcas4c n Act(GLI52,s 1(5)),apptiea6on by n homeowner far a 6cam or permit tray cvidcnoe Lhe
legal rU a of an oreployot undor dho Worker's C.ompoos.t Act
I undtrsuad ths3 a oopy of this dst---t m„y be fotww J d to tbo Dcpurcncxa of L,&,trisl A,,,6d.&Ottfioo of Lx uc• for the
coverage verificsiioa and that failure to soaax covaxp uDdcr section 25A of MOL 132 can lead to the imposiiioc of criminal pcnaltics
com tstazg of a fine bf up to S1,500.00 an&0C uxisoa� of tip to one year and ciQ paoxt&3 is the form of a Stop Work Order and a
fmo of sloo.o0 a clay again-tnc
For uw«o
Permit Number
7 j T Map# Lot#
Si of Li rmittcc
10. Do any signs exist on the property? YES Y NO
IF YES,describe size,type and location:
Are there any proposed changes to or additions ofsigns intended for the property?YES X NO
IF YES,describe size,type and location:
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This --I— to b,, filled is
by tho-BulAi-ng J)'-pax—nt
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - front
- side L; R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&pai,ed parking!
# pf -.Parking spaces
# s6f 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.
DATE: APPLICANT's SIGNATURE
NOTE: Is'd'uan/ a of ek zoning permit does not relieve an apps' mnVs burd-yell(6 oomply VOU7 4111
zoning requirements and obtain all require4 permits fromAhe Board of *iealth, Conservation
Commission, [department of Publio Works a3bd other applicable permit granting authorities.
FILE
--------------
' MM
APRz6
1-7f File No.&qw
DEPT QF BI,1?
ONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: ""`� ' ' t =�' r FIS Telephone:
i
2. Owner of Property�►1E (l"j W-
Address: 1'�S �1bi� >� Telephone: 41
L 3. Status of Applicant: Owner J Contract Purchaser Lessee
Other(explain):
4. Job Location: i
Parcel Id: Zoning Map# Parcel# / District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (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.
S. Has a Special PermitNariance/Finding ever been issued for/on the site?
NO DON'T KNOW >! YES 1F 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-1999-0884
APPLICANT/CONTACT PERSON Seigel Signs
ADDRESS/PHONE 113 Linseed Rd (413)247-5986
PROPERTY LOCATION 175 MAIN ST-FACES
MAP 31D PARCEL 142 ZONE CB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
T_ypeof Construction: REPLACE STORE FRONT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building_Plans Included:
Owner/Statement or License 053414
3 sets of Plans/Plot Plan
�
H LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presentedibased 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 ssion 01
Signature of Building 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.
175 MAIN ST BP-1999-0884
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31D- 142 CITY OF NORTHAMPTON
Lot: -001
Permit: Buildina
Category:renovation BUILDING PERMIT
Permit#_ BP-1999-0884
Project# JS-1999-1537
Est. Cost: $18000.00
Fee: $48.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Seigel Signs 053414
Lot Size(sq. 1): 22389.84 Owner: NONOTUCK SAVINGS BANK
Zoning_CB Applicant: ig I ions
AL: 175 MAIN ST
Applicant Address: Phone: Insurance:
113 Linseed Rd (413) 247-5986
WEST HATFIELD 01088 ISSUED ON.•4130/1999 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPLACE STORE FRONT
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 4/30/1999 0:00:00 $48.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo