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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. y 2'�Tel.No. Alterations
NORTHAMPTON, MASS. 2e:P1 19 Additions
_ Repair
' APPLICATION FOR PERMIT TO ALTER
C Garage
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I. Location i �' J Lot No.
2. Owner's name Address a
?4 Ire
3. Builder's name ` �% �t Address °t £'
Mass.Construction Supervisor's License No. ���� __Expiration Date
4. Addition
5. Alteration •' (' �� c� r.
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
14. Estimated cost;+0oo
'`tY� The undersigned certifies that the above statements are we to the be of his, her
knowledge and be
Signal a of responsible app icons
Remarks
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BOARD BUILDING iGONS
Icense: CONSTRUCTION SUPERVISOR
Number. CS 006457
Birthdate: 08114/1946
Expires:08/14/2001 Tr.no: 2733 1
I' Restricted To: 00
WILLIAM J MITCHELL
72 TEEWADDLE RD
AMHERST, MA 01002 Administrator
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m DEPARTMENT OF BUILDWG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
with a principal place of business/reside°nee ax:
�Pa i,
(stz�t/ci ty/staleJa p)
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 worl,�ng on this job:
(;�uU J 1:05 - CM 1 UJ�,�fi�� -
(Insumnce Company) (Policy
cy Number) (Expiration ate)
O 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) (lnsurancc Company/Policy Number) (Expiration Date)
(Name of Contractor) Onsuranc Compauy/Poky Number) (Expiration Date)
(Name of Contractor) (Insuran(-- Company/Poticy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach ad&boml sheet ifneccxury to mc}udo informitioa pat&ming to all ooatradon)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE-picaae be aware thus while homeowners who employ perzom to do�irAmzncc ooastructioc,or repair work on a dwelling of
not more than three units is which the homoowacr reside a oa tbo groin appurtcmat thereto arc not gmcralty ooaridaed to be
employexa under tbo woticc ooapcasatioa Act(GL 152,ss t(5)),application by a homeowner for a license or Pcrmd may evidence the
legal rl-h's of an employer under the Workcel CompcmaLim Azt
I understand dud:L copy of thu rntemcol may be foevnudod to the Dcpoxt cat of Indwt nal Am&o&Office of Imvrsoce for the
coverage vcnficatioo and that failure to somm coverago u adcr socfoa 25A of MGL 152 can Icad to the imPositioo of criminal pcmltics
coasut ug of a fine of up to S 1,500.00 andfor' f tip one year and civil pmaltics in the form of a Stop Work Order and a
fino o(5100.00 a day against mc.
1 For dcputmcat'l use m1y
Permit Number
Lot
MAO
Sigiiatiire of tacnscxJPc ttcc
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 colmn to ba filled in
by the Building D&partment
I Required
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
' &pac,ed Fay 7LL7g)
# of -Parking Spaces f
l
# of Loading Docks
Fill:
(vol-ume -& location)
13 . Certification: I hereby certify that the information contained herein
G is true nd accurate to the best of my knowled e.
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DATE: /_ APPLICANT's SIGNATURE r IL
NOTE: lasuanoe of a zoning permit does not relieve an applio nt's b rden to 0o h/ wi h '4111
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commisslon. Department of Publio Works and other applicable permit granting authorities.
FILE #
Wr 1 4 M9
File No. o3y DEPT GrdUlt<7'„G 'v
VyGRTH� r^TOAd. �?�;Otl=��ii
ZONING PERMIT APPLICATION (§10 . 2) �.
PLEASE TYPE OR PRINT ALL INFORMATION 72' i e4 J�R�
he+�5t o f oa z
1. Name of Appli 54B yq 3 3
Address: T ephone: �' 1 '`
2. Owner of Property: tt.
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
x Other(explain): +G
Cn
4. Job Location: _ 1
Parcel Id: Zoning Map# Parcel# S District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5 Existing Use of Structure/Property i lCff _
_ � A
6. Description of Proposed Use ork/Project/Occupation: (Use ad ' on I sheets if necessary):
w C >✓
`l. 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.
S. Has a Special Permit/Variance/Finding ever en issued for/on the site?
NO DON'T KNO A 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-7)(-- 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#BP-2000-0399
APPLICANT/CONTACT PERSON William Mitchell
ADDRESS/PHONE RFD 3 Teewaddle Hill Rd (413)548-9526
PROPERTY LOCATION 92 HIGH ST
MAP 17C PARCEL 153 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
1;-1 Construction• REPAIR POSTS BEAMS SILLS CLAPBOARDS STAIRS
New Construction
Non Structural interior renovations
Addition to Existing_
Accessory Structure
Building Plans Included:
Owner/Statement or License 000457
3 sets of Plans/Plot Plan
r THE OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based 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
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Comm'
Signature of Building Officiair Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
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92 HIGH ST BP-2000-0399
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map-Block: 17C-153 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:renovation BUILDING PERMIT
Permit# BP-2000-0399
Project# JS-2000-0685
Est. Cost: $4000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Grouy: William Mitchell 000457
Lot Size(sg.ft.): 16335.00 Owner: KAYE SANFORD&MARY C DONOVAN
Zoning:URB Applicant: William Mitchell
AT: 92 HIGH ST
Applicant Address: Phone: Insurance:
RFD 3 Teewaddle Hill Rd (413) 548-9526 Workers Compefisation
AMHERST 01002-9805 ISSUED ON.io/2o/1999 o:oo:oo
TO PERFORM THE FOLLOWING WORK.-REPAIR POSTS, BEAMS, SILLS, CLAPBOARDS, STAIRS
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: C) !a✓V�"
Footings:
Rough: Rough: House# Foundation:
Final: Final:
Rough Frame:
Gas Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: sff /5
THIS PERMIT MAY BE REVOKED BY THE CI OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 10/20/1999 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony pa*:"^