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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 5 9 S' 0 7 63 Alterations
NORTHAMPTON, MASS. -it,N i 2V -I 9-a Additions
' APPLICATION FOR PERMIT TO ALTER Gara
n Garage e
1. Location_ /0 U j �J/ZT� �l r L 2 f/�G .L G i b Lot No.
2. Owner's name Grdyg< Zom (;r C,J '1 LA) Address 14M C _
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3. °ui.'der's�yam,! 0 L 0`c 44 A Oki 1L-,N -H SMI T74 O(id C Address_ 4 ui 1 L1- 1 f"1 k�/,ff IT S-7-
�14
�� 1 ?
Mass.Construction Supervisor's License No. DU 5 -Expiration Date OIG
4. Addition N l( V1
5. Alteration 1 A)52/2L-A'77 �� �� P /4 3J'LU (
6. New Porch Ali A-
7. Is existing building to be demolished? -
8. Repair after the Fire
9. Garage No.of cats Size
10. Method of heating wva A S TU v t- 44,1(e — P&T IRA, yL44 J4 e� 1(
11. Distance to lot lines A,L1A
l2. Type of roof 420-
13. Siding house C D �►��,���s
14. Estimated cost_-
N `1
The undersigned certifies that the above statements are we to the best of h
knowledge and belief.
Signalurt of ru nsible appicant
Remarks _.
...DATE(MM/DDNY)' I L ' UE
, 0 /99
PRODUCER THI GERTIFIGA IF IS ISSI ILL] INFORMATION
METRAS INSURANCE AGENCY, INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
2030 MEMORIAL DR HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
CHICOPEE MA 01020 COMPANIES AFFORDING COVERAGE
COMPANY
200128 00 A NATIONAL GRANGE MUTUAL INSURANCE CO.
INSURED OLDE HADLEIGH HEARTH&HOME CTR. INC. COMPANY
B MAIN STREET AMERICA ASSURANCE CO.
119 WILLIMANSETT STREET
SOUTH HADLEY,MA 01075 coCaNv
COMPANY
D
G4ffiQS
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE(MM/DD/YY) DATE(MM/DDNY)
GENERAL LIABILITY GENERAL AGGREGATE $ 2,000,000
A X COMMERCIAL GENERAL LIABILITY 08/30/98 08/30/99 PRODUCTS-COMP/OP AGG. $ 2.000,000
CLAIMS MADE 1XI OCCUR PERSONAL&ADV_INJURY $ 1,000,000
OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE I$ 1,000.000
FIRE DAMAGE T50,000
MED.EXPENSE $ 5,000
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
ANY AUTO
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) $
HIRED AUTOS
BODILY INJURY $
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT -
ANY AUTO OTHER THAN AUTO ONLY
EACH ACCIDENT
—
AGGREGATE
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION AND
EMPLOYERS'LIABILITY TORY LIMITS ER !
EL EACH ACCIDENT $ 100,0OU
B THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT $ )00,000
PARTNERS/EXECUTIVE WIT74873 07/12/98 07/12/99
OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE 100 000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
)AFtTIFIAfiH3LREi�..:::;..' .'..>:; "»> GAhIGfLAT[4�N
.
.. ......
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
GEORGE LAUFER EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
10 DAYS JR N NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
1005 BURTS PITT RD AIL RE SUCH NOTI CE SHALL IMPOSE NO OBLIGATION OR LIABILITY
NORTHAMPTON,MA 01062 OF A Y K D UE COMPANY,ITS AGENTS OR REPRESENTATIVES.
AUTHOR E RESE T TIVE ff
ACt3Rt� 5�5(1/9S#: Q ACORD CORPORATIC3N 198&s
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bEPAMT ENT OF BUILDING INSPECTIONS
f M'Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFF'IDA'VIT
with a principal place of busine reside
(street/city/staieJa p)
do hereby certify, under the pains and penalties of pc ury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(lnsuranc:e Company) (Policy Number) (Expiration Date)
3 sole proprietor, genera contra--to,- huLLeOC nt' uncle One) and }'av= ' t 1
the contractors listed below who have the following worker's compensation policies:
GLb - N �Fr(�/ Kt T lS
t4- �C
N 3
(Name of Contractor) (Insuranr"Co olicy Number) (Expiration Date)
(Name of Contractor) (Insurance Compazy/Policy Number) (Expiration Dale)
(lame of Contractor) (InsZ=o-- Company/Pacy Number) (Expiration Daze)
(Name of Contractor) (Insuraace CompanylPolicy Number) (Expiration Date)
(attach additiocal shoot ifneocsssry to ir,-U taform ion pertaining to all ooafrndon)
( ) I am a sole proprietor and have no one worldng for me.
( ) X am a home owner performing all the work myself.
NOTE_p(caw be aware that wbilo homemt-ncra who employ per om to do Midut,-,,ace motion cr rcpair worst on a d"vcll of
not morn than tbroo units is which the homoowncr r=des or oa tbo group appurtcnatrt thereto arc not gcarally oon-k-d to be
cmploYas under tbo vmdccts compcnsation Act(GL152,sa 1(3)},application by a homeowner for a litter=or permit tray cvidcnoc the
legal etat u of as employer under the Workees Compomation Ad
I understand that x oc py of this rtacaxc i may bo forwarded to the Depu n=ot of MdU tid ADcidmra Offioo of In u—for the
oova-ago valficeloa and that fail=to socure coveraso under s6caon 23A of MGL 132 can lead to tbo imposition of c immal pcaaltie3
g or'fine bf ttp to$1,500-00 XnNcr iznprbonnxul of tip to one yea,-and civil pond is in the form of it Stop Worts OtdIr and a 1
fine of S 100.00 a day agninA me.
Foe 6T-tms>txl uao mty
�(} L
tt Pcrmiit Number T
j�, Nf*a 'ot rt
Signature of LiccnseelPcrnutfce 1
ktx'
10. Do any signs exist on the property? YES NO
IF YES, describe size,type and location:
&�)1 fY
Are there any proposed changes to or additions of signs intended for the property?YES NO
IF YES,describe size,type and location:_ /✓
11 . ALL INFORMATION MUST BE COMPLE'T'ED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
/ r S This colnam to be Pilled in
(�(, by the building Drpart�nnt
Required
I
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear ---
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parki_ngi
# of -Parking Spaces
# '6f Loading Docks
Fill:
-(volume--& location)
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
DATE: � 1 APPLICANT's SIGNATURE
NOTE: Issuanoa of a zoning permit does not relieve an applio nt's burden to pty W!t6,$ll
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
FILE #
File No t
a:ONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: f�o't I �
Address: !u u S [, a R i3 A r R-0 Telephone:
2. Owner of Property: lituvc c �'
Address: Telephone: S U7 3
3. Status of Applicant: ,Owner Contract Purchaser Lessee
Other(explain)::
4. Job Location: T3 A A .D
Parcel Id: Zoning Map# Parcel# w District(s):�axm ;
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5, Existing Use of Structure/Property Pt?('./ AI —"
L d t t�AYXU W 7)�- A,,--4 77/ 6t , ,Tl 4✓'' —
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/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__L_ 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)
r � ,
1005 BURTS PIT RD BP-1999-1145
GIs#: COMMONWEALTH OF MASSACHUSETTS
MapBlock:36-096 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:woodstove BUILDING PERMIT
Permit# BP-1999-1 145
Project# JS-1999-1899
Est.Cost: $4000.00
Fee:$20.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: "
Lot Size(sa.ft.): 15594.48 Owner: WRIGHT JOENE&GEORGE PETER LA
Zoning URA Applicant:_
AL- 1 QQL BURT
S PIT RD
Applicant Address: Phone: Insurance:
ISSUED ON:613011999 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL WOODSTOVE
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 6/30/1999 0:00:00 $20.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
rht ea s ^+Y ^^
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