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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. �G' � � Alterations
NORTHAMPTON, MASS. '�� 19 Additions
• Repair
' APPLICATION FOR PERMIT TO ALTER
Garage
1. Location Z 2-- 4/1 571A C �2�� x ��� �ni[ l//i51S� Lot No.l
2. Owners name��.iz.�.e e-^l ,�.l� Address j,9��i /i �✓�i e�G� ��ns�_ �.��5
3. Builder's name Address
Mass.Construction Supervisor's License No. 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
A Method of heating
1. Distance to lot lines
Type of roof
Siding house
stimated cost `Zf .0 a
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature o responsible,
e SEA 4 t9�8
� � i�, �iSEAC�ttS[t14
3E }r -DEPARTMENT OF BUILDMG INSPECTIONS
SdOi`il ._ 212 Main Street ' Municipal Building '
Northampton, Mass.' 01060
WORKER'S COTAITENSATTON MSURA.NCE AFFIDAVIT
(ll censer/perml U.ee}
with a principal place of business/residence at:
L c° o�o�t7(phone
(stre e uci ty/staidZi p)
do hereby certify, under the pains and penaltics of perjury, that:
O I am an employer providing the following worker's compensation coverage for my
employees wordrig on this job.
(Insurance Company) (Policy Number) (Expiration Date)
(Y�I am a sole proprietor, general contractor o homeown (circle one) and have hired
the contractors listed below who have the following worker's compensation policies,
(Llame of Contractor) Com-cauylPoLic NumEcr) (E.,-j rmtion Date)
(Name of Contractor) jnsurance ComDan- Poticr Number) (Expiration Date)
(Name of Contractor) (Insuranc: CompauyiPolicy Numbu) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach addttloall S3tC if ntCCTIa y to irKdu(1 fb-r= ra Pittw�'1'n�to all ttY 27aG0 7�
O I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aararc that ui-tilo homcoxncra ADO�3play perzous to do ' t coasrudion Cr repair work on a dNvclling of
not morn than throo units in which the homoowvcr residn or oa the Vvaadj apptrtcnaut t4crcto arc not ecncrally 000sidcmd to be
calployrrs under the worka's ooap=safion Act(GL152,ss 1(5)),application by a homeowner fora licros=oc PaMa may cvidcrxc the
1c&21 ct,w of an employor under thn Workoes Cornpcmalion Act
I uadcmund that a copy of this cistcmml may bo forn3vdod to tho Dcynrtrnc.d of Indsistzial Atcidm&Offsoo of Iuwrwoo for the
coverage vcrificsiioa and tbat failure to soazt oovcrn-o under socdoa 25A of MoL 152 can lead to the'imposition of criminal penalties
oomisting of a fine of up to S1,500.00 andlor i>z>psBOamcut of tip to one year and civil pcna2tics in the f—of a Stop Work Order and a
fine oC5100.00 0-Y against ma.
For dT=ta e W aaty
Permit Number
Lot
Signstixrc of T.iccnscc/P="1tice uare
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 col— to be filled 1n
by the R=1d=g 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 park.Lngi
# 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.
DZ E: �� APPLICANT's SIGNATURE oel�j -1
NOTE: 1 ua oe of a zoning permit does not relieve an applioanYs burden to oomph/ 'all
zoning requirements and obtain all required permits irom the Board of Health. Co sW44-ion
Commission, Department of Publio Works and other applionbie permit granting authorities.
FILE #
� � "
File No.f3E ppTN MA 106 �
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
t
1. Name of Applicant: /
Address: Z Z Sr` / k Telephoner
2. Owner of Property: i¢ �•./r
Address:Z 2 /`Lzz 2-:tee l p �lcur, Al�-,96 Telephone:
3. Status of Applicant: Owner A-"" Contract Purchaser Lessee
Other(explain):
r�
4. Job Location: �!Parcel Id:Id: Zoning Map# Parcel# District(s):
D I
(TO BE IL LE N BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property 6 E
6. Description of Proposed Use/ Work/Project/Occupation: (Use additional sheets if necessary):
y
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)
dig &.**
Department: Reference No: BP-.1.99.9-0273
....... . .... ...................
Building, Electrical & Mechanical Permits
Fee Yil;e: Receipt No:
Roofing
...... REC-1.999-000665
Pa ......................................
Paid in Full On:
Warren Riley Fri Sep 04>1.998
i�'—: ....... ...-•--------•-••--•- ...................................... ... ..................................
ceived By: Check No:
Linda :Lapointe 2101
.........................................................................................
..................•...................
DEPARTMENT'S COPY Amount: $20.00
...........................
DEPARTMENT FILE COPY 22 AUSTIN CIR
CITY OF NORTHAMPTON
BUILDING PERMIT
Owner's pulling their own permits or dealing with unregistered contractors for applicable work do
not have access to Guaranty Fund(MGL 142A)
Issued: Permit No: Inspector: Tracking No.: Fee:
04 Sep, 1998 BP-1999-0273 $20.00
GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size:
5077 29 353 001 22 AUSTIN CIR URA 29707.92
Contractor: License Type: Insurance:
Homeowner as Contractor
Address: License No.: Insurance No.:
gixi State: Zip Code: Phone:
Pro eect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0582 roofing $2,200.00
Description of Work:
STRIP & SHINGLE ROOF
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: