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17A-222 (3) i > > � D m 3 c oy < : •- Zpm � > cn 0 m polo- Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MASS. 19 Additions • Repair ' APPLICATION FOR PERMIT TO ALTER c Garage 1. Location 6 i k)ed74 44,4 a le -Sq- > Lot No. 2. Owners name ►h M /W Address I lL��,►�7� 14,74o/'Y .SO` 3. Builder's name JAA 01A � Address Mass.Construction Supervisor's License No. /1 ��'/ Expiration Date 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 �J 12. Type of roof cf t- `, 1-6 d-tT ,a 13. Siding house 14. Estimated cosL-1�CU()OJ The undersigned certifies that the above statements are true to the best of his. knowledge and belief. Signature of responsible appitcant Remarks 04 tfpTO � 6 t ? AUG, 2 3 I(Y1f1 :ssschnsctia _ DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT 1, � ,may^' (licen_seelpermi��ee) with a principal place of business/residence at: O SUS(phone#) —d'Y- -�---23 2 (streef/ci app) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: (Insurance Company) (Policy Number) (Fxpiration Date) 4-am- a sole pro pnet , 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 Compaay/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (anach additioml sheet ifnecessary to include infocsnatioa pertaining to all o atra ofs) (i4 I am a sole proprietor and have no one working for me. j ( ) I am a home owner performing all the work myself. NOTE:please be awaro that whilc homcowum who employ persons to do�,im ncr coasructioa at repair work on a dwelling of not more than throe units is which the homoowoer resides or on the grounds appurtensnt thereto an rot geoetaity ooasid«cd to be employers under the vmcker's oompe ns4on Act(GL152,ss 1(5)),application by a homeowrir for a Uccuse or permit may evidcnoe the legs!stabrs of an employer under the Workoes Compomation Ad. I understand that a copy of this szatemmr may be forwarded to tho Departmrat of I"L';Uial Attideats'Off o0 of Iasuraooe forthe coverage va-ificatioa and that failure to sour covcrago under section 25A of MGL 152 err lead to the impost -Of-k"-'penalties oanisting of a floe of uP to 51,300.00 and/or kgxisomnerl of tip to one ytw and civil penalties is the form of a Stop Work Order and a ' fmo 0f3100.00 a day against me. For use only /) Permit Number (' Lot# MaP S CY ermitxcc Date 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 —1— to be filled in by the Building 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 f 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. DA'Z'E: 2L}/9 9 APPLICANT's SIGNATURE Gv l NOTE: Issuanoe of a zoning permit does not relieve an 14pplion nt' urden to oomply wit"'all zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Department of Publio Works and other appiiooble permit granting authorities. FILE if i_.U° AUG 2 3 1999 Fi 1 e No. N E r � PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: ; In Q-A 4'!k'14 w 1 Address: �t1 t,V r ti /13 i" _Telephone: 57 2. Owner of Property: 2M.e rX &V"C N Address: 1 n�P2t �Lfit Telephone: 3. Status of Applicant: Owner ✓ Contract Purchaser Lessee Other(explain): 4. Job Location: fa' I l d- Parcel Id: Zoning Map# Parcel# District(s): (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property 6. Des ri ton of Proposed Use/Wor r ject/O cupation: (Use additi nal 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. r 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) 188 NORTH MAPLE ST BP-2000-0191 GIS#: COMMONWEALTH OF MASSACHUSETTS MaL:Block: 17A-222 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:roofing BUILDING PERMIT Permit# BP-2000-0191 Project# JS-2000-0311 Est.Cost: $8000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Groin Quinlan Builders 101707 Lot Size(sg.ft.): 17641.80 Owner: BRAMAN HELEN F Zoning.URB Applicant: Quinlan Builders AT. 188 NORTH MAPLE ST Applicant Address: Phone: Insurance: 5 Hillside Dr (413) 585-0949 HADLEY 01035 ISSUED ON:8123/1999 o:oo:oo TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE 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 siznature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 8/23/1999 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo