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LICENSE RENEWAL APPLICATION
PAUL D BURNS
22 KNIGHT AV
EASTHAMPTON, MA 01027
LICENSE TYPE: CONSTRUCTION SUPERVISOR
LICENSE #: CS 010752
EXPIRES: 08/09/1995
BIRTHDATE: 08/09/1944
RENEWAL FEE: $100.00
SOCIAL SECURITY #: 024-32-2482
Do you hold any other Massachusetts License as
an Engineer, Fireman, or Hoisting Engineer, Etc?
IF Yes, list: Type Class Number
A0
LICENSE # CS 010752
For State use only - DPS renewal
Please print corrections above.
RESTRICTIONS: 00
00 - None
1A - Masonry only
1G - 1 & 2 Family Homes
I am now Employed by:
�J19.SbNrZ
AS:
1 ce ii y under penalties of penury that to the best of my knowledge and beiiei the license information above is correct
and I have filed all state tax returns and paid all s taxes req ed b law.
Date Signat of pplicant
LICENSE WILL NOT BE ISSUED UNLESS ATTESTATION HAS BEEN COMPLETED AND SIGNED BY THE APPLICANT.
(Authority: C. 62C, S. 49L, MGL, as amended by C. 233 Acts of 1983)
"LICENSES NOT RENEWED BY THE EXPIRATION DATE SHALL BECOME VOID, AND SHALL AFTER ONE YEAR BE
REINSTATED ONLY BY REEXAMINATION OF THE LICENSEE." (Authority C. 43, C.146, C.148, MGL)
ENCLOSE CHECK OR MONEY ORDER FOR REQUIRED RENEWAL FEE (PLEASE WRITE THE LICENSE NUMBER ON THE CHECK).
MAKE PAYABLE THE "COMMISSIONER OF PUBLIC SAFETY". MAIL THE RENEWAL FORM WITH PAYMENT TO THE ATTENTION OF THE
CASHIER'S OFFICE AT,THE ABOVE ADDRESS. ALL CHANGE OF ADDRESS REQUEST MUST BE SUBMITTED IN WRITING.
Q
Zoning
a
n
Miscellaneous Additions, Repairs, Alterations, etc. Tel. No. 1-5 `-7'12 6S 7 7 Alterations
NORTHAMPTON, MASS. U//q/V 19 f Additions
APPLICaATION FOR PERMIT TO ALTER Repair
Garage
1. Location 7 dr11 G L �Z ' /V Z) ,f % f-//a/V 10 -P Lot No.
2. Owner's name X G / e� zf-�/q Address
3. Builder's name Z), /00/tcWS Address
Mass. Construction Supervisor's License No. e2 7 Expiration Date / �7 7
4. Addition
5. Alteration G %Cis c�/C'�SS 2) /J k� 7" �/ •`�'% T
6. New Porch
7. Is existing building to be demolished?
8. Repair after the fire
9. Garage
10. Method of heating
11. Distance to lot line
12. Type of roof
13. Siding house
14. Estimated cost:- 7'
Remarks
No. of cars S i
The undersigned certifiestha above statements are true to the best of his, her
knowledge and belief. , //
Signature of rgoohsible appicant
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 colum to be filled in
by the Building Department
ij. c:errixicatlon: I hereby certify that the information contained herein
r is true and accurate to the best of my knowledge.
DA=TE: / APPLICANT s SIGNATURE p ' �,
1 L
NOTE: Iss anoe of a zoning permit does not relieve an appl o nva burden to/fiHompty with all
zaning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appiioable perk -nit granting authorities.
FILE #
Existing
Proposed
mequirea
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
f %,f Loading Docks
Fill:
(vol -time--& location)
ij. c:errixicatlon: I hereby certify that the information contained herein
r is true and accurate to the best of my knowledge.
DA=TE: / APPLICANT s SIGNATURE p ' �,
1 L
NOTE: Iss anoe of a zoning permit does not relieve an appl o nva burden to/fiHompty with all
zaning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appiioable perk -nit granting authorities.
FILE #
�C JAN 4 15�
File No. n
ZONING PERMIT APPLICATION (§10.2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: / P(/��V
Address: Za L/E Telephone: 4�171 .3
2. Owner of Property: /7ril� / f _ �i�f
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other (explain):
4. Street Address: -%
—� V
Parcel Id: Zoning Map# 30? Parcel#.2-24Z District(s): 5
(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.
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 DONT 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 # 9 C 195- 5 4
APPLICANT/CONTACT PERSON:L I�A-2
ADDRESS/PHONE: `
PROPERTY LOCATION:`
MAP ; j� ('_� PARCEL:
ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERNHT APPLICATION CHECKLIST
L:XAAp`p_rove_d 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-Bd of Health Well Water Potability -Bd Health
Permit fro p4CpnservatjotvCommiss
Signature of Building Inspector
Date
NOTE: Issuanoe of a zoning permit does not relieve an applioant's burden to oomply with ail
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commlesion, Department of Pubiio Works and other applioabie permit granting authorltles.