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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. — $_ F! I Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location Lot,,No.
2. Owner's name Address
3. Builder's name '�/r'Giff Address ` > �o2-4i'
Mass.Construction Supervisor's License No. :?,° Expiration Date tl,- 4� > ,<r-•�
4. Addition
5. Alteration
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6. New Porch
7. Is existing building to be demolished? Y
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-
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The undersigned certifies that the above statements are we to the best of his, her
knowledge and belieL_2
11_n.-° tgnature of response 7t app icant
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DE TMENT OP BUILDI?lG INSPECTIONS
2h2 Main Street ' Municipal Building
Northampton, Mass. 01060 }V
WORKER'S CON PENSATTON INSURANCE El-M'IDAVTT
(Ii c�tLSerJpemv,tee)
with a principal place of business/residence at:
A�xe (phone#)
do hereby certify, under the pains and penalties of per3ury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
7- eel erz ScyC l�0O/1'03 id zada
(Insurance Company) (Policy Number) irarion Daze)
( ) I am a sale proprietor, general contractor or homeowner (circle one) and have hued
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Lnsurancc Comoany/Poky Numbcr) (E.:-pirntion Date)
(Name of Contractor) (llisurancc Company/Polic,r Number) (Expiration Date)
(Name of Contractor) (1-nsuranc-_ Compamy/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance CompanyJPolicy Number) (Expiration Date)
(atlarh addrtoa>1 sbtct if m6cc'sary to mchl e Mf0CMxt1ofl Rc wfrhno to a ccatra r')
( ) I am a sole proprietor and have no one wor-Eng for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that while homcowncn wbo cmplay perzoos to do maintcaancS coastrud3on"or-parr work on a 6Yr_L ng of
not mom than thtuo unit,in which the homeoavcr residn Of m the groan'!'appuftcasni thadn arc not genernlly oowidcrcd to be
cmployas under the worka's oomp=sation Act(GL152,ss 1(5)),application by a homcowncr for a 11—a permit may cvidcoce the
legal elms of an eurployer under the Workce,Compeinatioa Ac L
I undcrsiand thud a copy of this ctatcmcat may be fcr var t4 the Dcpertmc of Indrutrial Aocidrnt�OfS f f�a«
coverage verifiestioo and that failure to serum covmr under soeiion 25 A of MGL 152 can lend to the impos3t
ooaus ms of a fine of up to S1,500.00 and/oc imprizossma ofup to one y=and civil.pcnaitics is the form of a Step Work Order and a
t
find of S 100.00 a day agaimi tnc
For depuun-w use only
Permit Number
Nfap# Lot#
of i ermittce
10. Do any signs ebst on the property? YES NO g `'
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 c02mmn to be filled in bT the aai2ding Department
Required I
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(LOt area minus bldg
&Paved parking)
# of Parking spaces
ht 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
DATE: Ile- APPLICANT's SIGNATURE
NOTE: Iss no of a zoning permit does not relieve an a toant' den to oompty tl au _
zoning reg irements and obtain all required permits from the Board of Health, Conservation
Commission. Department of Publio Works and other appiioobla permit granting authorities.
FILE #
j '.
o,S �1. 5 '
cpt OF 8011 Fi 1 e No
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: �
f° _ Telephone: 7 �
2. Owner of Property:_T
Address: � Gvt�S�=7 �. Telephone:
3. Status of Applicant: O%vner Z--Ifo—ntract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# y, Parcel# L District(s):�`(r�
(f0 BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed UseNVork/Project/Occupation: (Use additional sheets if necessary):
7. Attached P ans: 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 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)
9 WILSON AVE BP-2000-0040
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C-351 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:roofing BUILDING PERMIT
Permit# BP-2000-0040
Project# JS-2000-0070
Est.Cost:$1600.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Alan Shumway 013908
Lot Size(sq.ft.): 3528.36 _Owner: FRANK KENNETH W&MILA C
Zoning.URC Applicant: Alan Shumway
AT. 9 WILSON AVE
Applicant Address: Phone: Insurance:
625 EAST PLEASANT ST Workers Compensation
AMHERST 01002 ISSUED ON.71mag99 o:0 m
1
TO PERFORM THE FOLLOWING WORK.-INSTALL MODIFIED BITUMEN SINGLE PLY OVER
EXISTING LAYER ROLLED ROOFING
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 7/16/1999 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo