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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. • £ Alterations
NORTHAMPTON, MASS. Ig Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location 1Z 6G� P10, Lot No.
2. Owner's name �l r W Address 1-1 9
3. Builder's name O)' Address l�
Mass.Construction Supervisor's License No. Expiration Date / 10 45 /
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 healing
11. Distance to lot lines / } L f
12. Type of roof r�fdt'�;� /� J T�u` X15✓Za
13. Siding house
14. Estimated cost-
The undersigned certifies that the above statements are true to the best of his
knowl�lie
Signature of responsible app icant
Remarks ! /%� d,�' jet, � �S~�'� a/r'i tS
r
O
s� °g Crz onztl�ttlittnt� z
$ e AY 4199 1
� u � 1 �lassachnsctls -
MI � ?F:i`4 ���; 'i� � DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • MuuiciPal Building '>o
INSPECTOR
Northampton, MA 01060
Applicant Information /�
Name 1/��vl� v -----------------
Location
City-------- --------------------
❑ I am a homeowner performing all work myself
❑ I am a sole proprietor and have no one working in any capacity
191I am an employer providing workers' compensation for my employees working on this job.
Company Name �% ------- --
Address --� 4�' ��.`----------------
City—,� , ------ --- Phone
Policy Insurance Co. � — –
Company Name
Address
City Phone#
Insurance Co. Policy#
Failure to secure coverage as required under Section 25 A of IvIGL 152 can lead to the imposition of criminal
penalties of a fine up to$1500.00and/or one years'imprisonment as well as civil penalties in the form of a STOP
WORK ORDER and a fine of$100.00 a day against me. I understand that a copy ofthis statement may be
forwarded to the Office of Investigations of the DIAfor coverage verification.
I do hereby ce u e p s an s of perjury t -1 the information provided ab e is i e and correct.
Signatures Date
Print Name , ' /�Jt�'� ,te _Phoney
Official Use Only Do not write in this area to be cornpleted by city or town official
City or Town Permit(License ❑ BuillinsDept
Lrensing Bond
Check if immediate response is required
El se>e�'Dept.
Contact Person Phone 3P-
Health Dept.
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 colu= to be filled in
by the Building Dcpnztment
(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
&paved parking)
# of 'Parking spaces
# 'of Loading Docks
Fill:
-(volume -& location)
13 . Certification: I hereby certify that the information contained herein
is true nd a curate to the best of my know ge
DATE: APPLICANT's SIGNATURE
NOTE: Iss r; of zoning permit does not relieve an applicant's ' rden to oompty witF� all
zoning ulra ants and obtain all required permits from the Bcl rd of Health, Conservation
Commission, Department of Publio Works and other applicable permit granting authorities.
FILE #
f;
MAY 41999 File N9 4PM
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: ��. . �1 41'
Address: l.� J .z u� / Telephone: <-�,21/,/9
2. Owner of Property: �v C
Address: Telephone:
3. Status of Applicant: Owner y Contract Purchaser Lessee
Other(explain):
4. Job Location: 3Z Ke—l�lxlllll Ag _
Parcel Id: Zoning Map# Parcel# (7' District(s): �
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional 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.
8. Has a Special Permit/Variance/Finding ever bee . sued for/on the site?
NO DON'T KNO:AI YES IF YES date issued:
IF YES: Was the permit recorded at the Regis cif 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__Zll 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)
39 GOLDEN DR BP-1999-0913
GIS#: COMMONWEALTH OF MASSACHUSETTS
MV.-Block: 29-422 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:roofing BUILDING PERMIT
Permit# BP-1999-0913
Project# JS-1999-1574
Est. Cost: $5800.00
Fee: $20.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: PHILIP BEAULIEU HOME IMPROVEMENT 100073
Lot Size(sq. ft.): 36633.96 Owner: OSOWSKI STANLEY P
Zoning.URA Applicant: PHILIP BEAULIEU HOME IMPROVEMENT
AT: 39 GOLDEN DR
Applicant Address: Phone: Insurance:
217 Grattan St (413) 592-1498 Workers Compensation
CHICOPEE 01020 ISSUED ON.•5/4/1999 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 Sianature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 5/4/1999 0:00:00 $20.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo