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17C-153 (6) < y z = a -a OZ m O o _a 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 a 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 � P fe-���� 01 c4rx�f" 1, I r CC( Vr�k- GO i Ogce c;awl sPc�ce I r 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 '1M>t:.;;•11.!C»...:�n'.. ...i.-('��...{ r....i1!(:v.K�.w�.',....h�..,:.:{F:» i+..f..'v�.+.t....'^,i<'�.0 •.�......(+.(. ......':.+... ....� .. . ,......,.n,. .., e. .�, s. .n...n...,. t Y':r V"bkmp� :O �Op s e (riN of 'Nart4ampfall L � B �asaacaasctia 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. r 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. - Y �.� _.*t �-`w,,. __ _� - s 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*:"^