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17B-011 (2) r ( > - r- m o N ca > Z o' -� y z Z a O c m Zoning Miscellaneous Additions,Repairs,Alterations,etc. f Tel.No.5`56— FY cf j Alterations NORTHAMPTON, MASS.—j 22 19 Additions ' Re APPLICATION FOR PERMIT TO ALTER pair t� Garage 1. Location ! f �r Q C `� Lot No. 2. Owner's name aa1; PStJ- Address wa-,>L1 ,'1- /]- ,A, J Go S I`t e� 3. Builder's name Odd!RN1�S �'Qf/c t� P S y ),)'1e '7 2o`j G-,:qcrJSr Mass.Construction Supervisor's License No. 00;2-7-D 2- Expiration Date 4. Addition 5. Alteration Re rd D4' ^ S.D Jill 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 Ns.le l-t A 13. Siding house 14. Estimated cosL ®� J l The undersign d certifies that the above statements are we to the best of his, kn a belief. Signature of responsible appicant Remarks N ew c9 o O���fPTG � � �lasaar}lttsrtts WV 2 2 No TMENT OF BUILDrNG INSPECTIONS 12 ain Street a Municipal Building ' DEPTnOF SUfLQ'tSG iN�PE�TIONS orthampton, Mass. 01060 RWORKER'S COMPENSATION INSURANCE AFFIDAVIT O ,A Si ty I-'li e Ne/iermittee) with a principal place of business/residence at: 2 I-dCVC'+ Si d r--p- -t (phone#) (street1dty/sta1dzip) rev 5'-62 - D 2 7�-- do hereby certify, under the pains and penalties of penury, that: I am an employer providing the following worker's compensation coverage for my employees wworlang on this job: im P r i Crx IV JfA?7s Z we S 3510 d 2 B (Insurance Company) (Policy Number) lion ate) ( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired the contractors listed below 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) amsutrance Compauy/Poficy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additioml sheet ifneoessary to iaclWje information pmtaining wall rogation) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:pleas be aware that whilo homeowners who emptay p=om to do maintca nor oonstrrution or rcpair work on a dwelling of not more than throe units m which the homeowner resides or on the groins appurtenant thereto am not generally oon deed to be employers under the worlues compensation Act(GLI52,ss 1(5)) application by a homeowner for a likens or permit may evidence the legal stahra of an employer under the Workeet C.ompemation Act I understand that a copy of this stateaxat may be forwarded to the DcQa tanmd of Industrial Acci&n>'Offioo of Insruanoe for the covmW vcrificatioa and that failure to secure oove:r V under section 25A of MGL 152 can lead to the impoaifioa of ctiminal penalties oomisting of a fine of up to S l,SOO.00 andtor iapriso�of up to one year and civil penalties in the form of a Stop Work order and a f=orsloo.00 a say against tat gPermit pi use caly / Number C Lot# of LicenseefPermittee 10. Do any signs ebst 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. Thia ccl-= tc be filled iu by the P-2di q, peps r 30n t Required I Existing Proposed By Zoning Lot size i 2 �A S a �_._..- Frontage 2 00 r—) Setbacks 3 5 - side L:1�0/ R: '`D L: - rear /00 ", Building height 5f (a Bldg Square footage ( ��� %Open Space: (Lot area minus bldg &Paved parking% # of Parking spaces #` of Loading Docks Fill: vol-ume -& location) D 13 . Certification: I hereby certify that the inform ion ontain d here% is true an accurate to the best of my kno a )---' DATE: ! � �2 APPLICANT's SIGNATURE NOTE: 1 nano of a zoning permit does not relieve ati appl ants den to oompty with-,ail zoning requirements and obtain all required permits from the Board of Health, Conservation Commisslon, Department of Publio Works and other applionble permit granting authorities. FILE # File No. A'v 53d ZONING PERMIT APPLICATION (x'10 . 2) PLEASE, TYPE OR PRINT ALL INFORMATION 1. Name of Applicant:0'e�t�"" � �Pr/; f �j��y I ov, Address: Z Qx ls- S7 00E-Of Telephone: 2. Owner of Property: oa j i r 9 � Address:WeZ41"AJ t,i©S�Q,Telephone: S' 0 2161 3. Status of Applicant: Owner Contract Purchaser Lessee V 0 Other(explain): --t �!a C it- 4. Job Location: Z oy f Ueie �—1 o► er"C_e Parcel Id: Zoning Map# Parcel# District(s): (TO BE FILLED �� IN BY TWE- BUILDING DEPARTMENT) 5. Existing Use of Structure/Property fC.-.e S rJ E`ti 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): 1�p0e�—' — SCqJlk S Ij -4� 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 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) 400 BRIDGE RD BP-2000-0530 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17B-011 CITY OF NORTHAMPTON Lot: -001 Permit: Building Catego :rr oofmc BUILDING PERMIT Permit# BP-2000-0530 Project# JS-2000-0920 Est. Cost: $2000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Skyline Design 002722 Lot Size(sq.ft.): 19994.04 Owner: PESUIT DAVID R&ELAINE ULMAN Zoning:RR Applicant: Skyline Design AT. 400 BRIDGE RD Applicant Address: Phone: Insurance: P O Box 142 (413) 586-8491 FLORENCE 01062 ISSUED ON:11122199 0:00:00 TO PERFORM THE FOLLOWING WORK.-SHINGLE ROOF OVER 1 LAYER 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