Loading...
17A-008 (5) 39 LEENO TER BP-2020-1062 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-008 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categorv: ADDITION BUILDING PERMIT Permit# BP-2020-1062 Project# JS-2020-001422 Est.Cost: $60000.00 Fee: $390.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: LEARY BUILDING COMPANY 104806 Lot Size(sa.ft.): 13503.60 . Owner: KACZENSKI JOHN J Zoning: RI(100)/URA(100)/WSP(100)/ Applicant. LEARY BUILDING COMPANY AT. 39 LEENO TER Applicant Address: Phone: Insurance: 13 GLENDALE WOODS (413) 336-2611 SOUTHAMPTONMA01073 ISSUED ON:4/29/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-8x12 KITCHEN ADDITION POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frank: 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 Sisnature: FeeTvpe: Date Paid: Amount: Building 4/29/2020 0:00:00 $390.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 ` Louis Hasbrouck—Building Commissioner DeparUnatuse only -- City of Northampton status o€'Permit Building Department Curb CuttDriveway Permit If. ,t ` 212 Main Street Sewer/Septic Avaftbiky Room 100 Water/Well AvagabWft (: Northampton,.MA 01460 Two Sets of Sbuck**Plow phone 413-587-1240 Fax 413-587-1.272 P dsite Plans {def Sperry APPUCATtON TO CONSTRUCT,ALTER,.REPAIR,RENOVATE OR TIEMOUSH A ONE OR TWO FANKLY(DWELL NG SECTION 1-SfrE MWOR MAIX0 1.1 PropartyAddr+e35: This,section to,be cor WkAed by office t: , -. /'� 501 ��o ►FaZStaeoe � � Lot Va-9 tlriit 4_ �dd �°'ne Oveclagr'Disnict sr.O iCt CB DisMa f; SECTM 2-PROPERTY OWNERSMWAUTH ,r 2.1 Owner of Record.: Al',L,t , &,- C615S.tC� U Arn E AS AsztJ G Nana(Pnnt) Cur re,n tM alin .Address: n lei 7,,,)) �S(o . j 4 g� Signatwe 2.2 Authorit+ed:Ag,er& 3 C OP4z' /"J cvr_�����f a P inti,f MA ero-T 5 Name(orint) Current Mailjmq Address: Signatur Tel n SECTION 3-E TED CONSVQJCTION COSTS Item FSt MIed goat(1306rs)tD be OffidW Use Onty ,comptetedby permit appftwd 1. BWIding 'S—O 00c) (a)&Ading'Permit Fee 2. ELectrical (b).Esti Tont Cost of �D O d Cin from 6 3. Pknnbing �D SuAding P'ernit Fee 4. Mechanical(HVAC) 5. Fire Protection ,! &. Total=(1 +2+3+4+5) (QU i 6 c c) CMS Number This Seetkm;'Futu Official Us 10" Bu; Pertrst ter_ 6 -i61,1 1 : 1 Signature- 0 1 VV i u*Wig GomfftsskwwAnspector of t3uftngs EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 'Sa -z-0-U"UL' W Section,4. ZONING t Information Mkcst,Be Completed Re mink Gan 6e Denie&©me To Incomplete In.forrnation, Existing Proposed Required by Zoning Tbis,column to be filled in by Building Dqurmwnt Lot Size Frontage Setbacks Front Side t.: R: L R: Rear Building Height Bldg_Square Footage % Open Space Footage %e (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Locaum A. Has a Special mit/Variance/finding ever been issued for/ora the site? HO � Dt3NT K Q YES 0 W YES,date issue#: W YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT`KNOW 0 YES 0 W YES: enter Book paw and/or Document# B. Does the site contain a brook,body of water or wretiands? NOfa DONT KNOW U YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be abWaed 0 Obtained 0 , Date issued: C. Do any signs exist on the property? YES 0 NO lF YES, describe size, type and:Eocation_ D. Are there arty proposed changes to or additions of signs intended for the prgxrty? YES ® No I IF YES, desaibe size, type and toca kwL E. Will the correction acbviity disbab(dearing,grading.-excavation,or filling)over 1 acre or is it part of a common plan #tsad vaH disturb over 1 acre? YES No IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTIOM.5�DESGRfPTIOR'OF PROPOSED WORK((check all applicable) New House. ❑ Addition Replacement Windows Alteration(s) Roofing Ur Down 0 , Aeeessory.Bldg. ❑ Demolition ❑ NewSigns [p] Decks [M Siding[L]] Other[a tk4ef DescWtiof Proposed Work: - _r�{12 �t�unEu hi'iioU Alteration of existing bedroom Yes_�No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement 'ries Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following. u. Use of building : One Family�_ Two Family Otho b. Number of rooms in each tm*unit: of Batb wootns c. is there a garage attached? ;yo d. Proposed Square footage,of new construction. Q(p D'imensi'ons � x I Z e. Number of stories? ,(�iNC,I.0 f. Method of heaUN? ut'a wk 0212 F4rsp4acez or Woodstoves�_Number of each g. !Energy Conservation SJc3nioarrcre. Masses EneTW Compliance form attached? h. Type.of construction ( i 6 J _ i. is oorvstructk>n within 100 ft.of wettands? Yes �_No. Is constructionwithin 1;00 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade (� k. Will building confofm too the Bu ttirrg and Zoning regulations? lyes No. 1. Septic Tamm Citi Seweir _ Pnawate well City'water Supply SECTf0I4 7a!-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject Arty hereby:authorize to act on m 'behalf,in al mafters relative to work prized by thrs'butlding pertmtapplication. If L Zy . Signature of Wner Date qas-ChtarerfAatJn©rued Agent hereby declare l et the statemeints,and informatien on th&faregoing.appiieation araArve,and aewrata,to,the,best<of my knoyAWSe. and belief. Signed under the,pains and penalties of perjure. M Print Name c ? L v Signature of GkwuAgepA I Date SECTION 8-CONSTRUCTION SERVICES M uteased;Edon Supervisawr: Not Ap abla� EY Nww of License Haider: G /0y 'koc Licanae Number 2 I 1- 2 Z Address Expiration Date. A)5 ZColl Signat T . 2� 9�/@t� Itlrli8'�M�IDTGVQ7T11.M11 Not Apple �I' 1NC 1�10(0� Co any Nam Reg�stsation NCmbes !�tayhkLf, 1,.)Mt s Na O(D Address Expiration Date. Tel�Qe��3(0-2lo i 1 SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152,§25C(6)) Workers Carnpensatm Msurarwe aff,4ama rrxwt be au n*ted arra wbMifted.W&'dais appi,icatm.Fagure toprovide this affidavit will result In the denial of the issuance of the building permit. Signed:,ffrda�rit Attached Yes..... No...... ❑ City of Northampton htassacnusetts DEP1R ? OF'BUI&DING ZMP.EC'47CwS t '212 Mlai.n Street •ltaniclpa3 Sutlding �k a`� J Northampton, MA 010,60 Debris Disposal cif f idavit In accordance of the provisions of MGA c 40, 554, f acknowledge that.as a condition of the.building permit all debris resulting.from the construction activity governed by this;Building Permit,shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGI_ c 111, S 150X The debris from construction work being performed at: (Please print house number and street name) Is ilio tm disposed of at: (Pie*e p int n me and brAtizn ofIaciiity) Or will be-disposed of in a dumpster onsite rented or leased from: (Company,Name and Address) SignaAPermiti or O e ate tf,for any reason., the debris will not be disposed•of.as indicated, the Applicant or Owner shall notify the Building D;qpartrn,aml,as to the-Iocatbn wh re,the debris will.be disposed. ThC C4==0RI*VWth'I!f es-,wcArumm Department of IndustrialAcddews I Ca"gre5SSftW4.SIri& mo Boston,MA 012114-2&17 WW .Mal&90$YW0 It eclters'Ce asa h"mwawce AffikFaviP8e 3erslC - TO"11TWED V"TT&THE PUMITTING AUMMUTY. Applicant Informad6s Please Print Leeib NaM,'Cj'(Bu,sinossYOrganizati@iAndividuul)- Address-- /'I (,Lc-jjbAjjE City/State)Zp. O(CIII Phom#- Ki �3& . z(oci Are-you an enioloyer?Chefk the appropriate bm -rype ofproject(required): 1.Q I am a employer with eMPIoyccs,(full,&wi/;ar part-time)." 7. F1 New constrtiction 2,M I wnwsefle pmpfictarer partnerOip fmd'havemo,emoloym wattking Forme yin K E] Remodeling ary�capaairy.[Nonworkers"aermpArsurance,requimiL] 9. F�Demolition 3111 1 am a4honicowner,doing all work'Iny-acif.;[No workers',,=Mp.,insurmec.required,],I 4.M Lam,a hanwownimand will be hiringeentractors to-canductall vorkramrrgy,propett�y Twill tuvat IhVL 7,11 vantmnzrs tither'hvmwzvkvw compensation insurance ex,Ut sole ve-ptim et addition proprietors with no employees. 112.DINambing repairs or additions 5.E)1 am a gmenfconnmcrnrand?ftavchirecf&ciuh-wnmctnrs,lfRWA on the attaafidd 4hott, 1117W)of repair These sub-conwaaarslizve employees and have ww4wrs'c=p-,jnsu=w--' XW{e area,corporation and its officem haveex=ci wA their right of exemption per.MGL c. t4.00,tficr 52,§1(4),anal wchave nQ,cmployccs.[Trio works comp,insurance required.] *Any appi wam chat checks boot 41 mmu alba fa out the se tion Maw shiavnng their warkm'cantpensation *iey mf tier. Hamcourncrs who submit this a1ridavitindicating they arc doing,ail work.and thenhire outside contractors must:submit a new affidavit indicating,sucli- :Contractors that check this box must attached an additional sheet shoriing the name of the sub-contractors and state whether or not those entities have emo,lovees- If the sub-contractors have cuployees,they roust provide their workers'comp. aumber. 1,ain an.entployex.thatis providing workerecompensation insurancejbrmy, ployaes. Belvw,is,the policy madjob site in, ormativ& InsuranceZempuay Na=.- .Policy-#or.Self-im.Lic. Expu*um Date: Job Site Address: City/State/Zip: Attach:a copy of the workers"compensation policy deciParation page(stowing,thi polky nninber and expiration date). Failure to secure covenage as requitvd,undcrMGL c. 152,§25,k is acriminal violation punishableby a fine upto8l,500.00 and/or one-t'e'ar anprisminwnt,as weWas eivil VenWtws uv the forest,of a3"YOP WORK ORDER'aadaf fum-of upta,$250.00 a day against the violator.A copy oCthis statement may be forwarded to,tha Office oflnv�tigatioa&ofthe DIA,forinsurance. coverage verification. I do,hereby certify n' nif �Wties edizrp that the hTfannadOn prori&d'aftare is trar and correct, Sip-nature: Date: 'Phone#: CK Official use only, Do trot write in this area,to be completed by cACK or,town officiaL City or'Town: P.0VMitfUC4MW 4 Issuing Authorlty(eirele one).- 1.Board of Health 2.Building Department 3.City,'Town Clerk A.Electrical Inspector S.Ptembin-g Inspettv 6.Other II Contact Person: Phone FOR 153 The Commonwealth of Massachusetts DIA Use Qply--., Department of Industrial Accidents Office of Investigations-Dept. 153 1 Congress Street,SuW.100,Boston,Massadnme s 021142019 http--/twww.mass.goV/(ria in 1D � AFFI.DAVIT OF EXEMPTION FOR CERTAIN CO `�R'TEriusTi;n pCCIUENTS OFFICERS OR W ECTORS Chapter 169 of the Acts of 2002 ament*d M.G.L. c. 152, §1(4)' by adding the foUbwing paragraph. "This chapter shall be elective for an officer or director of a corporation who owns at least 25 percent of the issued and .outstanding stock of the:corporation.Notwithstanding section 46,these provisions shall apply only if the corporate officer provides the commissioner of irndustrnab accidents with a written waiver of hi�rights under this chapter. Said commissioner shall promulgate regulations to carry out the purpose of this paragraph. Violations of this paragraph shall subject the corporation to the penalties set forth in section 25C." Pursuane w >'+%�.4:1,. C. <152, .c l;a ; roc T 11Wte t��e., ,t atirgr n oea Leary'Buildingp Inc. 1.039 Eaat'ftuntain-ftuad,Wesffield,MA 01085 (N- ne of Cw"nWoa.a nx AdYh mY, each holding at least 25%of the issued and outstanding stock in said corporation, do hereby invoke the �risght to be exempt from the provisions of M.G.L.c. 152, §25A and therefore are"-,required to carry a workers' compensation policy covering the undersigned corporate officer(s) or director(s). I/We the undersigned do also waive any and all rights to make claims for befits as defined nn M.G.L. c. 152 for any injuries that may be susraiiwd while in the employ of the above-named corporaationi Furt1w,]/we the undersigned db,understand that,should the above-named corporation hire or have in its employ any employee(s) in addition to the undersigned corporate officer(s) or director(s),said- corporation aidcorporation is.required to obtain workers' compewmion coverage for tike employee(s),as prescribed by M.G.L.cA52,§25A. I/We the undersigned have read and understand the statements and-obT ga tons gas-delineated--abso"e and I/we'Iiave checked the appropriate box below ray/ma ie(s tg my/our desire e eXMpt.er not to be exempt from the provisions of M.G.L. c. 152. r-~ ftpwd the pains w0yemifies of per .ury: �^ e Tmir-Att,y A. Lean7, President 07/15I2094 Signokure Print Name&.Title Daae(mmlddlyyyy) zI wsh m exendse my or F I clash NOT to exercise my right of exemption Signature Print Name&Tide Date(mmOdd/yyyy) ❑ 1 wish,to:ememise;my+rrght)ofexcemption or ❑ °l wish 1TQOT,Iotxer sesmyt4.htofcw.Mption Signature Print Name&Title bate(mmldd/yyyy) ❑ I Wish to exercise my right of exemption or [] T wish NOT to exemisee-my right of--n tion 'Signature Mat Name&Ti& Date(mmtdd/yyyy) ❑' a wish to exercise my right of exemption or C] i wish NOT to exercise my right of exemption Note:ALL UAGHRI.E CORPORATE OFFICEM MUST SIGN. TIi EAE CAN$E NO MORE 1'XiAN 4 SIGNATURES. IffstructiOns on back. Fwm 153-712010 W mp �Mmmmmmmmmm FROWN "WON m wwwwwwwwrAVA MMEMMER'sommom ■■■■■ E■■■■■■__11� EMt1/■■�■■�!■//!/I■ ■■■■■ ■■■iii■iii■■■EME►MER■■/I■II■■ ME■EMEREM■MEMMUME■■■E.■,.■;.;.■■ mommollsommommEm Lim ■■�■ME11■EEEriir■!■■■ ►I■m/■lr1EM■ MEESE ■■■MMMI���!!■■■■!■!�/■►���■SEMI■II■ on ■■■_ _.�,�■■■■.�■■■■�■■■■■■■■�Ei\ilk■■ ■■M■■■E■■■EwAMM SIM ■■M■■■EM■■■llmmm��M■■■ ■■ ■ ■ ON Iv■■■ ■ 110 ■ ■ ■M �1�■ ■■■ 11000 ■■ ■■■ ■■!■ ■ HOME ME M 0 NNE NNE M■M■■E■M ■■! ■■■■■comm B■■■ ■■■■■■MEMO■■ ■limmoi■�►I_ _ HOME illi■ M■M■MMENONE■ \\\1111 ■11■EE ■■M■■EE ■HEMI 1■�■O\E1III■ 11M■■ MEMME■M ■E■■1■i■■■IseMEN 111 MEN■ MEMMrEMEMMI►\��OOiOEll iiSEE /MEMEMEMEME No MEMEMEME No SME MEMOM■EMM MUMEMEREENE/E■■MMEMMEMEMMEME No EE MO■M■MME■MMM /MME■MEMS■■■MM■■EME ■■■■■■■■■■■■■■■■■■�i�]�l■■�lE■@iii■■■■■■■■■■■■■ ■iii■■■■■■■■■■■■■G -'its:' ,fir llfi' I`.�■■■■wi ' I ■■■■■■ ME ■ ■ ■■■o■��■�l��i■■■■■■■■■■■■■■■■■■■11■■■■ ■■11 ■■■i���■ l�i11!■■■■■■■■■■■■■■■■■■■■11■■E�■ ■■11■■■■■■■�i.�7■r■■■■■■■■■■■■■■■■■■■■■11■rel■ ■■I� ■■■■■��i� i �■■■■■■■■■■■■■■■■■11■■■■ ■■i■■■■■■■■■■■■�■■■■■■■■■■■■■■■■■■■rl�i■!�■� Florence lank MONEY ORDER 249299 85 vialn Street 20 53-7168/211$ FNarence, MA 01062 CUSTOMER COPY DATE arch 10 PA;f TO THE ORDER OF:_ � �1���;.JC14F One Hundred and 0011,DO***********t*". DOLLARS MEh10_ f �-il-1 ay _ NON-NEG_OT_IABLE QUFC.NASER Florence Bank MONEY ORDER 249298 815 IV1aihStreet CUSTOME€�; COPY 53-7168/2118 FL)rence, MA 01062 DATE March 18, 2020 PAY TO THE ORDER OF: /--7 One Hundred and 001100*r************s**s**** DOLLARS �w _ �"'�: _ NON-NEGOTIABLE �v At t7EMO: PURCHASER h MASS NAIL IT, LLC Certificate of Cornpletion For the follower courses: IRC &Mass. Amendments Course Approval #CS-2300, IBC, tEBC & Mass, Amerm1ments Course Approval #CS-2301, IECC Energy Course Approval #CS-2302, Business Practices &Workrnan15 C_oinp Course Approval # CS-2303, Lead Abatery ent Course Approval #CS-2304,Workplace Safety Course Approval#05-2305 Awarded To rl"Ir M 0 T ' I 1Y A L]EA.-D-xr License Number: CS-1048016 Awarded: March 15, 2020 Mass Frail It,LLC 12 Lawrence;Street Michael tsiampietrg Milford, MA 01.757 CSL-CD-0023 This educational offering Is recognized by the Massachusetts Board of Building Reglulations and Standards as satisfylrlg 12 Hours of credit towards CSL education requirements. File.u MP-202WO-W4 APPLICAN.VCONTACT PERSOM KACZF.NSKI JOHN a& BARBARA A ADMft&%i'k,)KF 9 LMt1+iO' ERI PROPERTY LOCA•ITM 39 LLLNO TGR AA 3 ��PI'X�Y'iM�'l A,:#.wu�a .3t9a� t�.rr wx; a� .�'►v+x 1�L,3.:.»S�'i lUV .�.:trot•���1��.trt��•[•ri����H�.:t�.�.rsT� INC DSH) REQUIRED VA'S'E Zr�VENG MR-M- 11 I err Fee Paid Bui Binaenat_sl�tf Fuc Paid Typeof Constru+etigar ZPA-SX 12ADDITION. Mgw C_ onstructicxt ____ Nor StrMeaeral,ift nor senawatiaM6 Add1 itipn fio Existiing,, _ A"vmwN Structuve I tii►d n,„t'"t s Included- owneri stateLn rt car!.ice_ns 3 sits(7f Plags!.Plot Mier T44f FgIAOWING AC'T4K>NN SMAS—SWI, TAKC N ON VMS Af'4'4A-CAT40N SASWOON fSV;F ?1�IAT4�Al FRF:SiE:IN`TirFL<: Apprt►►wcui --A4dibojud fermi r:aqu3recl(se+e beJ�,o►y 1stbWttttczcki le ErcZject.. Uiw-°l3„ Major ftjt&._.__ _Sil Per t'#NWOR Spe:ia Pe nnik with Sky.M= 's ZONING WARD PERNM RKQUMED UNDER: i Specia ttit _ Wacaa"W Rceei el' I4� eieel»f)t`egi tryy a�f F ends {r Fneltw"ed �,._—:CWb C';t4:f ,9VW -M-at r Avai:abil ty ' r Ava labi]iry _Stpfic Approval Scaarr ►FMMM _. _._ ►Jtf tat r}cila tl Board of T i ______�l'ermit from Cs�nsec�ation C€tmniissiAn _______-_t'ermit fram'Ct3Archita�ture C�utmittee Permit from,Elm Street Cmwnksiva Permit MW 1,14 re Waver Manetement Signature c uiftfing Officials t r Notir l9wance of a Zoning perm-icdow novrefidve u appl3rAu.C&hur(towto,compq,witft;all`zonii requirements.end obtain:til required permits ira:n Board of Health,Cvnser'ti:atio�t Commission,Department *f Oblic wor.6i xrrd nttlear pAlital►1e rt it Rrtrntin .aiitlmrifics *Variances are.granted onh-ito,,tbuse applicaets who;FrxvA the strict swndards of 1VIGL 46A.Comad Abei iee,of P'ianni4g&Developmenl for Vlore information. �r —2-0 r /i( 7,ONINGPERMIT AEPLJC.4,TION (§10-2) Please type or print all information and-m-'t-ro, is form to the Building Inspector's Office with the$30fili rgfee(check oi-mantylorderYprayabte to the CityCityof,Ntwrlptorti 1, game of Appticant: Y Addrexs: Tetephone.� ' 2. Owner of Property:_. A t Teiephone: 3. SUtus of Applicant: Owner Czntmct Purchaser Lessee Other (explain) 4. 0catism .-, Parcel �z,�. in& . 1, t P �/1 f`�'n1 71 creel �G�: vr�to�g i�u sn { c'frcel# _ i Vr 4.,- Irl, sIn.!`'trio Street Distnct in Centrat 1{usiness District (To BE FILLED IN BY T-iE BUILDING DEPARTMENT) f 5. Existing Use of StructuretProperty: �WW.C4 vrac.�<twiwv�uaa nvww�scuu urira�rv�aii�:.r`r�i��,.rtauiics+�a�ewi�: �a�oe. a,a�iraiaare+ei5 W ieCr554ry"j: ( s �. Attached Plans: Sketch Nan Si►e'Man r � c it�:ii,ccre&rYejie=dP imui's 8. Has a Special PermitiV*iance/FWWing eves been issued far.ton the site? IV DO r KNOW YES IF M,date issued: F VM Was the permit recorded at the Regi+:of D 4 IF YM enter Book paw andJ+or Document# ��.Does'theittL-c Iain-;a brook. body of er(orwetlands? NO 'DON'T Kh CYW YES 'IF YES.t as a Permit n or need to`be obtained from the tonservation Commission? lieeds to'be obtained.__ �...a_ Obtained date issued: fEom Coftfluut On Other S4d*)i t+�_l�it�ureenti�t(�{R:l�4�krxs�in+a{t131uir#n�+�Ik��gan�dosun}g{a'acsni�,�p{{cat�a�nhpivs:.dfre �4 N �. 10. -Dvosn s:•siRtts.wtist on.the,prgperty? 'YES '► iF YEri,>z N)e 5te,''typeiand location: Are thewe ar t p opmed changes,to or additions of signs,intended for,theproperW. YEs KCl:+ tF YES,describe size,tape and 66reatiarr: St. WV the constructiont activity disturb(clearing,grading,excavation„or filling)Xacre:or is,it part of a,c ornmon plan of development that with disturb over i acre? YES NO :4F' ,tkem&Nwthimptoa SiQitm Water Managerwnt Pemnitfrom the'.,DPW is;re aired. 12. ALL INFi"Ji2MiA'n0N,MUST BE COMPLETED, or PERMIT CAN BE DENIED DLJE"T0,LAGK 0F)IKf*f AATi$W This:ealtann reserved for use=6g the building Department Fxis,nNG i PROPOSE1) REQt{1RFD RV fi ZONING Lot'aize Soo Frontage Setbacks Front Side L: ., R: S L: ' R: L: R. Building Height Building`Square Footage Open Space: (lot area minus building Et paved' Im p,Yf j4 of Parking Spaces #of Load"Docks Fill. 1010me EL iucaiion { 13. Ciertification: i geretW/ flier`that'the irftrrrtatvn1 tonlxajniW'h*tein is'true and somArate1wthe best of my knos ledge. 'Date, l . G Applicant's Signature 1 . NOTF:Issuance ofa.aoningpermit,doesnotrelieve anapplican burden i mply-Aithalltemin requirements and atpta i all required permits from tlxc Briar ill nservation Commission, Histone*ad Arr¢hffixftrat Boards;,Department of PUbffc Works and-other applicable permit granting authorities. Gy Chi�T�R t aci imsl?f3udldin�sFees}xxmrZwnan -('saasutr.�srar�licadmn-�u iud.ds *141--%4 rt'.Cpert),..lJetuj:4. ttttU:. ,��avv' i; •ae::tsxxx{.xx+raeoaacaava.u�:allyla4J�k/xa/tJWt,�u��uia.YiaY.wxw��w.., pg� E i arty ofNGftharnp n —1 Rosi b ial Proper B=ard Card ; ?titw S +K4 €ropaw.Tvw C.d;51`71. l Codd Rc Car Y G' k" t5-Location Zont slew ml a Bl ifs-008 001 inz�- i�� �_tack-Lot; ��.�.�, � Assrssnaeni: �1=att5xET: II 't`E, 'Ne' 14 Lss.ztcl. 98,70 iving,1 nits: t Deed Boom 1932 Buil qg: 421,100 'tl -1iATaal: 2119,800 Deed?age: Pwrlling Inftannation 'I Style, ►Year Built: t5 . R Story Height: £ t Attic: NOWr t Basement: ; E NOMI RIU(?MS:. �� t� AeiFr`s Bedrooms: a�EFP t Fl BisEnsu: esrar 0 1F4 psi 9� t wc� ' O. !.r�lfrB�ttts: � j AuTier`walls: FTUMl a :Carry v UAnished Area: '7rildlta: lt4 Am: zol '9� " �tti+'+ F.fOH {Total Living Area: 143541 ca" 32 xot {' Finisibed Bm=cw Living, ` Area: ] Basement Rer e�,tion.Area gad t i` oodburning Firepiwe f Stackslt aeniogs: Meta[Fireprace it l El ° E } ; Stac:}cstOuaigs• MeaOCawml A/C: Fu--1 Type: i 7 C ,A1. 3li�Q1`i3C1tYfl: i Quality Grade. Physical Condition: Average.�t av�Ywr I��Stcary +lnd Slaty :3 rd Story'Area __ - - iateriarfExtczicM Same° i11 amemwt Ow Story Front eAnd1. tE3WiJ+ L1° -Sl J : GD `Etldodd.Frame Ph7MN Wood De& 55 Adki�ona.f Fea mvs canopy j 53 , j Brick Trims Q,X alr One&Qry Frarne �_. —�-- �g�q i toneO'X 0 i i� Frame flccr3ran s f 321 A*Mo fiAg Ijtta: 2Id2/2.007 10:48 AM Of A F t 1 t 4 I , , i + 1,•,y,.. #'*..,«u ...:L...m ,+'s•. e.,..r .y, ...i+» :.»y.x.,....r:1.....„ r�..»y.• .;.,. y»,..-..1Y.r � t., ..,.•1'• *bvm �a. r«r�.. ,�,.......,.s�.,.�»�f.wmw�, f e ..�.. .. .�.. r a ..- ..�L ; - ....�.,. ..,,d y.,.....,_�-�'•: ilk e L4 �:v...r.,��.�w..-�..y,.f i......-....�. .i.:...... .«�.wy,..- �..r.:.»w ^�`^�• •r� ;k-w.... -.-..yt... ... � a -.- ., .:y, ._ y......a..}�_ .... .�».,<.»..�.»o.,..�.,�.....b,. .,.+w,.•._- �...»...� �.-.:.,.....1.,.. ..w... ... ....a _....� y.,..,. .,...,w,ir, 1,. _, -�.. -.,r- Ez..,..._.�;:: t v� f s a d ' 4 r { 5' { 1 X e + F ._i ' �....+-..�..w..,...i....r...�......r�..�r :w,«a. '^".^_1C""""",.{.""....` :",'..'yF°..-,.,�...�..-d x,�+...... ....j•... ......+... .._..:. ��.. �. �VN,�41P ....�..y.. ' 1 • y r , 1. t t r h^^-i..l-...�...�...r.� �.,.».« ;�.....e.,-�.:.....7..._. .�....»...�,..,...,.� .{..».., �.,,..r. ..--i:.., y..,....--F � ..�,. ��-� �-��....�}�..--•i»,.r---•'`a.,.:,.......*...k,F,.,,....-�#........f.,.. f,.«-.�..«...,._j........:.y.. I� .-,.iii,I....-....Sr...¢.�.yF... t by..-,,...3..�-.J�.. .j,..,.,...�s _y....... a._., ,...'t-. .g.,.h-�+ }..,........ _,,...?::,.... ,�t,�...,...1�,. .. i ..,.....a. i....«, .l-..:s.-,�i... q..»._,...�.,.,...-..t,-'-«r-r.• a j 3 r 1 `s CY:a4RY"1tti.''z+:W 2�. '.T "^'�•r• )- f. a < ii i