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17A-147 (5) i D m E 3 ; Zm CD c o R � z y Z C a 1 = O� z a Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MASS. 3C� 19 Additions Repair APPLICATION FOR PERMIT TO ALTER / Garage 1. Locatiord i j�,4, Si Lot No. 2. Owners name l Address Ak(S Nj S1. 3. Builder's name A, nun 1,AMMT Address 1-3+-1 Mass.Construction Supervisor's License No. ,�/ /G Expiration Date e-9 4. Addition 5. Alteration 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 2 S ti„� ac l-`f CJ tic 13. Siding house 14. Estimated cosL- The undersigned certifies that the above statcmcnts are true to the best of his. knowledge an lie . Signature of responsible appicant Remarks s 4— g R'� CrxaL of &X=t4antp#un a e �asrtciittsctta DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass.' 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT o C, A tLYA (licenscdpermittee) with a principal place of business/residence at: Qvqk SJ Fp,-I, N, 013,AQ (phone#) (s6tret/city/sta&2ip) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following worker's compensation coverage for my employers working on this job: (insurance Company) (Policy Number) (Expiration Dace) I�a sole pronriet general contractor or homeowner(circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurancc Company/Policy Number) (E.xpiradon Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale) (Name of Contractor) (Insurance Compa ry/Policy Number) (Expiration Date) (ate additioml shod if neoenj y to inchsdo infocrosrion pcttaining to all ooahudon) ( I am a sole proprietor and have no one working for me.. ( ) I am a home owner performing all the work myself. NOTE:pl use be aware dul whilo homcowncm wfio camplay pctsow to do maartca constructicaor repair work on a dwclling of not mote than tluoe traits in which the homoowocr rcudca oc oa tha grounds appudens t lhacto are not gcoemLly aonsid"*cd to be employers under the svodcces oompeam4ca Act(GL152,ss 1(5)).application by a homcowncr for a ticc=cc permit may evidence the legsl datut of an employee under the Worlcoes Companuiim Ace. I understand that a copy of this cszicmcca may be fammded to the Deparemma of Industrial Aoddm&Oboe of IawAsu a for the overage verification and that Cailure to teattt cowmSo under seuioa 25A of MOL 152 can lad to the imposaioa of criminal p-16:1 oomisting of a floe of up to 31R500.00 and/or iVrisomnent of tip to one year aid Civil pension is the form of a StoP Wa t OtJw aid a 1 fine of 5100.00 s day s iod tna FcrdgtttthWda W0onhr Signibrew of po=scr/Peanittee 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 colrmn to be filled in by the Bailding Department Required 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 parkingi # of Parking Spaces #r of Loading Docks Fill: {vo1-ume--& location) 13 . Certification: I hereby certify that the informat n contained herein is true and accurate to the best of my knowledg DW1"E: �- ")fl'`(� APPLICANT's SIGNATURE � k) - NOTE: Issuance of a zoning permit does not relieve an applioant's burden to oomply "'It"ail zoning requirements and obtain all required permits from the Board of Health, Conaervtation Commission, Department of Public Works and other applicable permit granting authorities. FILE # AUG 3 01999 File No.9 "" d OL ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: f;,J 6 tJi A DucJ� Address: S AvQ�SI _ �As tyY-n �w Telephone: �� 2. Owner of Property: At"')g FT Address: 1 -1 Telephone: �S 9 a 6 o 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): 4. Job Location: 9A o 1 k--A x J e,( , �� ►� Parcel Id: Zoning Map# 17# Parcel# District(s):.� (TO bff FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property t 1A1�t Lz 12'4 5 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): j P- G rL�?� kz£ 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) w 256 CHESTNUT ST BP-2000-0209 G1S#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A- 147 CITY OF NORTHAMPTON Lot:-001 Permit: Buildina Category:roofing BUILDING PERMIT Permit# BP-2000-0209 Project# JS-2000-0339 Est.Cost:$4000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Wayne Ducharme 118101 Lot Size(sq.ft.): 22346.28 Owner: TELEP DAVE Zoning:URA Applicant: \ ayne Ducharme AT: 256 CHESTNUT ST Applicant Address: Phone: Insurance: 15 Gaugh St (413) 527-8940 EASTHAMPTON 01027 ISSUED ON.8/3o/1999 om:oo TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE HOUSE & GARAGE ROOF 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 Sienature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 8/30/1999 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo