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F. J. Dzialo & Associates
7 /9 /Q Consulting
Structural
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Registration
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Massachusetts
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FREDERICK
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c°a DZIALO
No.17657 1
�MNAL.
- 19 Pleasant View Drive,Hatfield,MA 01038 TeIlFax 413.247.5740
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No.17657
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10. Do any signs exist on the property? YES NO t. {
IF YES,describe size,type and location:
r
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 cold to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size 'f <-
Frontage
Setbacks '
- side L: R: _ L: _R:
- rear
� c�• � fir'` J
Building height '. \4
J
Bldg Square footage ,Y t
--- C J_
%Open Space:
(Lot area minus bldg
&paved park.i.ng) CCU
# of -Parking spaces
# of 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.
/1
DATE: � - r_9 6 ` , APPLICANT'S SIGNATURE
NOTE: Iss anoe of a zoning permit does not relieve an apa'Iioant's burden to oomply with an
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appfioable permit granting authorities.
FILE #
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� File No
, ,�ONXNG PERMIT APPLXCATION (§10 . 2)
i PLEASE TYPE OR P=T ALL INFORMATION
2. Owner of Pnoparty
Address: Telephone:
3. Status myApplicant: Ownor __L~__Cunbact Purchaser Lessee
Other(exp(ain):_______
4 Job Location:
Parcel Id: Zoning Map# Parcel O|stnot(s)
(TO BE FILLED IN BY THE 8(JIL0NC DEPARTMENT)
�
5, E)dshng Use ofStructure/Property
6 edUoo/VVo noj (Use additional sheets
Ic-
. . ---_- Plans: Sketch . .-.. _---__-_-Site . .... ..g...~..~~...,~y�. Plans
Answers to the following 2 questions may be obtained by i--hecking with the Building Dept or Planning Departirnent Files.
8 Has u Special PernniUVahanoe/Finding ever been issued for/on the site?
�
NO- DON'T KNOW YES /F YES,date issued:
IF YES: Was the permit recorded ot the Registry ofDeeds?
NO DON'T KNOW YE
IF YES: enter Book Page_______ and/or Document
Q. Does the site contain n brook, body of water orwetlands? NO DON'T KNOW YE
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs tobe obtained Qbtmin* .date issued:
(FORM CONTINUES ON OTHER SIDE)
FILE
APR 31998
APPLICANT/CQNT,ACT PERSON: 2&ffi 2 ' 3
A.DDI0,SS/1%OXE:
PROPERTY LOCATION:
MAP PARCEL: ���� ONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERK UT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
r
Rl�ilrliny Permit Filler! Hilt
Fee Palf
Type of C'nngtl rtinn-
New C onctrnrtinn
RPmndelino TnteriQr
Addition to Fxistina
Arreccnry Strurfiire
nilrlinu Planc Tnelntlerl-
0,wner/Orrnpant Statement or Licence
3 Sets of Pinnc /Pint Plan _
THHF,.FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION: <
Approved as presented/based on information presented
T 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
Appr"bval Tad of Health
Well Water Potability-Bd Health
!Permit from Coonnss"ervrvatio ommissio i
Signature of Building for Date
NOTE: Issuanoe of a zoning permit does not relieve em applioant's burden to oomply with all
zoning requirements and obtain all required permits from tha Board of Health, Conservation
Commission, Department of Pubiio Works and other applioable permit granting authoritles.
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BAPR 3 PO' �:sattrpnsrtta
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building 'o
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(licensee/perinittee)
with a principal place of business/residence at-. ,, !a
f-t~��l-&V,� 044- aooz- (phone#) �ST3. 2-^
— � (strevt/city/sta4jziP)
do hereby certify, under the pains and penalties of penury, that:
O I am an employer providing the following wor-er's compensation coverage for my
employees worldng on this job:
(Insurance Company) (Policy Number) J (Expiration Date)
O I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have 'le following worker's compensation policies:
(Name of Contractor) (Insurance Company/Poky Nu.mbcr) (Expiration Date)
(Name of Contractor) Rusuran c-,� Compauy/Policy Number) (Expiration Date)
c
(Name of Contractor) (Insuranc-_ Company/Pobcy Number) (Expiration Date)
(Name Contractor) (Ins�lrance Company/Policy Number) (Expiration Date)
71amml:hect ifnoocsury to mch%&mfvrmatioa pertaining to all oocjtr s)
a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:pica=be aware dwd wbila homcownm who employ parsons to do maint all.constrtutiou or rcpas work on a dwcUiag of
not a'Qm than throe units in which the hogyoowncr resides or on the gr od,appurtenant Ihuew arc not gaocrally considered to be
emPloYera tinder the works compensation Act(GL152r31(5)),application by a homeowner for a license or Pcmii may evidence the
legal ctatua of as employee under the Work z Compemcdon Ace.
I understand dud a oopy of dda zritcmcni maybe forwnrdnd to the Dcpartaxa2 of Industrial A=4eo:!Office of Irnvrwoe for the
eoverx verification and that failure to t;oatre oovcrago under soctioa 25A of MOL 152 can lead to the imposition of criminal penalties
oomisting Of a fine Of up to S 1,500.00 aadror imprts Zit of tip to one yutr and civil penalties in the form of a Stop Work Order and a
fum of S 100.00 a day against mc.
For dcpartnxw use Only
Permit Number
I,ot#
tgnaltire of LiocnaexlP,
C'A L to CG -S
a= Crff�7 >-rf 'Nart4aiilpton
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'909
f�li3EKC1(It5rllE
APR 3 t
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
o S
(li censeeJpermi tt ee)
with a principal place of business/residence ac
bI71,cc.k S1 (._-f'�� )Ylfiss (phone#)
(Stre U6ty/statrhiP)
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 working on this job:
(Insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general c,=Mctor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies_
(Name of Contractor) (Lnsurancc Company/Policy Number) (Expiration Date)
(Name of Contractor) (Laauancc Company/Policy Number) (Expiration Date)
Z
(Name of Contractor) (Lnsuraucz Company/Policy Number) (Expiration Dale)
(Name of Contractor) (Lnsmrance Company/Policy Number) (Expiration Date)
(-ach additioml rood ifneceuary to include iafcrma oo pcxtniuing to all ooatracf.on)
am a sole proprietor and have no one working for me.
( ) T am a home owner performing all. the work myself.
NOTE:please be aware thrt whilo homcouracra who anpl oy pc=m to do mxtntcaaw�,cousmidioa or repair work on a dwelling of
not-or*thaw tbroo unia is which the homoowncr resides�x ca the gourds appurtemni thereto an not gmaally oomidercd to be
eIISploycra under the wo(ICG 0xvcas4oa Ad(GL152,ss 10)),application by a homeowner for a Eccnsc or Permit may evidmcc the
legal stylus of an employee under the Workoet Compec am ion Act
r undastaud that a oopy of tbu rfaacoacot may be for%mu�ded to the DcpnrtmmQ of la&L-orial A=doo&Offioc of Iawrsnm for the
coverage vaificatioa and that failure to scarce oowngo trader suction 25A ofMGL 152 can lad to tbo impmitioa of aimmAl pcmitics
oomist=s of a fine of up to$1,500.00 zn&or impriuo :d of up to one year and civil pcmWcs in the form of a Stop Work Otdcr and a
fins 0(3100.00 achy against me.
For dcgartmwbd u---Y
t Permit Number
_Lot#
,_. S03atz of Liomsedpermittee T— e e
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cr) = F
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19— Additions
APPLICATION FOR PERMIT TO ALTER Repair
a Garage
1. Location 6-`j-ei1j&1it1,,Wd 57- f; 161f&exa m S Lot No.
2. Owner's name J 5 a le<L f-Ff ell Address &,) S-/ 'T
4n Address 7 62e S' J s
3. Builder's name , )-,
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration iz ryn trp-v ('�a -5�2:2 PC Ci v�( S)ra` er,,,) IVW 120�1, 4EEk��,
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 -4,� S l CA,-
14. Estimated COSL-
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
Signature of responsible appocant
Remarks
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 i-'
IF YES,describe size,type and location:
I1. 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
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: ,'' R: ''
- rear
Building height i
Bldg Square footage
%Open Space:
(Lot area minus bldg
&peved parking)
#
of -Parking Spaces
# of Loading Docks
Fill:
-{volume -& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE:
A/' APPLICANT's SIGNATURE a a"11M / Lt4'
NOTE: Iss anoe of an zoning permit does not relieve an ap iioant's burden to comply with all
zoning requirements and obtain all required permits frony'the Board of Health. Conservation
Commisslon. Department of Public Works and other applicable permit granting authorities.
FILE #
APB 3 Pa
-� < 0
File No.
ZONING PERMIT APPLICATION (§10 . 2
PLEASE TYPE OR PRINT ALL INFORMATION
—w.�.—.,
1. Name of Applicant:
Address: `', i�`YlGC S/� r"F'�f 0 1 Telephone:__ S %y S �
2. Owner of Property: �;�111PS UY1C cS I Fc-f'sA
Address:_ ` 3 K,4Cj u� 0 t(-LL) !>/ -Fiy,evto Telephone:
O1 C`
3. Status of Applicant: Owner ,,,""Contract Purchaser Lessee
Other(explain):
4. Job Location: �� C�PG_KGt ! 5-5 �Ur �cG [mac.
Parcel Id: Zoning Map# �T Parcel# rf �— District(s):
(TO BE FILLED IIV BY THE BUILDING DEPARTMENT)
5, Exjsting Use of Structure/Property P VCi. Ay5 i C�J-1 Q
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
Z V11101I( ec From -0 '5 ccAc I
S.7cc(.l Pc&i`i
p R
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_ �°d/ 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 t''f 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
s. LIaA CONTACT PERSON:_
ADDRESS/PHONE: _ C2�?
PROPERTY LOCATION:_��
MAP PARCEL: lg ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERNUT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZQNTNCT FORM FTT.T,FD OTTT
Fee Pnid
]Rnildin2 Permit Filled nut
FPP Paid &
13nilffing Plan-,TnrlurlPrl-
3 Sets n Plan-, n Plan
THE LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION'
Approved as presentedfbased 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
'%a>;epc' ''P Fi)w d of Health Well Water Potability-Bd Health
Permit from Conservat' Commissi n
Signature of Building; ector D to
NOTE:lssuanoa of a zoning permit does not ralieva an applioant'a burden to comply with all
zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commission, Department of Pubiio Worka and other applioable permit granting authorttles.
City of Northampton REQUIRED INSPECTIONS
} 1. Footin s and Walls
BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
NO. 1554
Office of the Building Inspector
-
Zoning Form No. 963373 Date 5/8/98 Fee $168.00 Check# 1645
Page, 17A parcel 102 ,Zone URA Section 127 ❑ Yes 0 No
BUI]LDINGPERMII
*Plumbing and Electrical Inspections required
THIS CERTIFIES THAT John Punska before Building Inspections
has permission to construct 2nd story & install siding & fireplace Inspection on Site—Foundations
cvtnnterl nn 13 Grandview Street - James McSheffrey Inspection of Plumbing—Rough
provided that the person accepting this pen-nit shall in every respect Inspection of Plumbing—Finish
conform to the terms of the application on file in this office, and to the Gas Inspection
provisions of the Statutes and the Ordinances relating to the Construction, Inspection of Wiring—Rough
Maintenance and Inspection of Buildings in the City of Northampton.
Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring—Finish
of this permit.Expires six months from date of issuance,if not started. Building Inspection—Rough
Note:A certificate of occupancy will be issued by this office upon return Insulation Inspection
of this card signed by the Plumbing,Wiring and Building Inspectors.
Building Inspection—Finish
** Install per Manufacturer's information: windows,vinyl siding,roofs Smoke Detectors(Fire Department)
and woodstoves
Other
` THIS CARD MUST BE DISPLAYED IN A CONSPICUOUaj4sA ISES
Certificate of Occupancy
Building Inspector