32C-211x` E
Miscellaneous Additions, Repairs, Alterations, etc.
k'f
1. Location
Tel. No.
NORTHAMPTON, MASS. 19
APPLICATION FOR PERMIT TO ALTER
0
Zoning
Alterations
Additions
Repair
Garage
Lot No.
2. Owner's name �\cJ„� �vJ2c Address
3. Builder's name R s- C�r`3�������� Address �� � 5�� k)ftn2k...>n
Mass. Construction Supervisor's License No. C2 , c��— Expiration Date
4. Addition �-
5. Alteration �-� Q l �, C--
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:- f r
The undersigned certifies that the above statements are we to the best of his,
knowledKe and belief. � t
Signatuie of responsible app,icant
Remarks
IN
TU
Grx#� Of'lazt4ttnlpton
�lasERCljn8r11E
NOV
2 2 �yy� � PARTMENT OF BumDrNG INSPECTIONS
2 Main Street a Municipal Building '
a
,FPT OF R! CIi T7,;, Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(lice=sedpermittee)
with a principal place of business/residence at:
Q "�c �� �`�;trti �c-�U hone# /«l
(streel/city/sta3rJap)
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)
() Isole proprietor, g eral contractor or homeowner (circle one) and have hired
the contr e ow 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 Comparr/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheet ifneaessary to include information pertaining to all oontractom)
() I am a sole proprietor and have no one working for me.
() I am a home owner performing all the work myself.
NOTE: plea= be awam that while homeavnas who employ prions to do mainleaaace construction or repair wotic on a dwtuiag of
not more than three units in which the homeowner resides or m the grounds appurtenant thereto arc not generally considered to be
employers under the worl(ces oomp=sation Act (GLI 52m 1(5))� application by a homeowner for a license or permit may evid— the
legal status of an employer under the Wodcoes Compensation Act.
I understand that a copy of this statement may be forwarded to the Departmmad of Industrial Aocidaa& Office of Iasursooe for the
ooverago verification and that failure to t ecw c coverage under soction 25A of MOL 152 can lead to the imposition of criminal Pmdfies
oomisting of a fine of up to $1,500.00 and/or imprison of up to one year and civil pcnzWes in the form of a Stop Work Order and a
fine of 5100.00 a day against tna
For dial nae oody
Permit Number
Mai{ Lot #
Signature of Licansee/Permittes Mte
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 eolnmm to be filled im
by the Btd ding Deprzc=ent
-� • �-i+i�u� 11J11. i 11Clt!py ceruiry that the information contained herein
is true and accurate to the best of my knowledge.
DATE: APPLICANT's SIGNATURE
NOTE: Issunnoe ofa zoning permit does not relieve an appiioanva burden to oomply with7all
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 #
Existing
Proposed
rcequirea
By Zoning
Lot size
Frontage
Setbacks
- side
- rear
L: R:
L: R:
Building height
Bldg Square footage
%Open Space:
Lot area minus bldg
&Paved parking)
# of "Parking spaces
it of Loading Docks
Fill:
{ volume -& location)
-� • �-i+i�u� 11J11. i 11Clt!py ceruiry that the information contained herein
is true and accurate to the best of my knowledge.
DATE: APPLICANT's SIGNATURE
NOTE: Issunnoe ofa zoning permit does not relieve an appiioanva burden to oomply with7all
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 #
0v7n
NW2 21"
File No._�
0 P OF 8liif n�p;r, INPfCTI')�o;,
PERMIT APPLICATION (§10.2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: CK� C -n sk A • sa �Ci, Ce-
Address:
eAddress: �� \JJ`� ��� Telephone:
2. Owner of Property: N`y C
Address: \Telephone:
3. Status of Applicant: Owner Contract Purchaser v Lessee
Other (explain): ��-(�
4. Job Location: / ? k%P.►�tl� '< 1
Parcel Id: Zoning Map# ae— Parcel# / District(s):
(TO BE FILLED IN BY THE UILDING DEPARTMENT)
5. Existing Use of Structure/Prope rty.�(�^-L
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
CA'j 114
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 KNOV. 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)
.r
47 HOLYOKE ST
GIS #:
Man Block: 32C - 211
Lot: -001
Permit: Buildin
Category: roofing
Permit #
BP -2000-0531
Project #
JS -2000-0921
Est. Cost: $2400.00
Fee: $25.00
Const. Class:
Use Group:
Lot Size(sq. 8.):
1568.16
Zoning URC
BP -2000-0531
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
BUILDING PERMIT
PERMISSION IS HEREBY GRANTED TO:
Contractor: License:
STEPHEN PHILLIPS 121892
Owner: COOPER ALVIN L & JEANNIE J
Applicant. STEPHEN PHILLIPS
AT. 47 HOLYOKE ST
Applicant Address: Phone: Insurance:
P O BOX 566 (413) 586-1969
NORTHAMPTON 01061 ISSUED ON:11/22/99 0:00:00
TO PERFORM THE FOLLOWING WORK. -STRIP & 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 Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 11/22/99 0:00:00 $25.00
212 Main Street, Phone (413) 587-1240, Fax: (413) 587-1272
Building Commissioner - Anthony Patillo