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„5 Zoning
Miscellaneous Additions, Repairs, Alterations, etc. f , 9 Tel. No. - 775/ - 117. — Alterations
J Repair
,�,� %ter NORTHAMPTON, MASS. 19� Additions
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,, APPLICA FOR PERMI TO • LTER
Garage
1 . Location 4 i . . / , , . , - . 7 - / 0 - „ A v i , - e / ` R 4 L No.
2. Owner's name i� : .r. ////C-4 o Address �g � / ' • .4 /P
i
3. Builder's name 'ad r - tl Address r .� ..../ L / OA* WW1 rC ' 3a/
Mass. Construction Supervisor's License No. (' S. 7,O Expiration Date e
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 heating
11. Distance to lot lines
12. Type of roof L.2 . - -to
13. Siding house
O 0
14. Estimated cost: - Al /
The undersign : certifie i at the above Alai. . are true to the best of his, h(
knowledg • d belie . / /
/
1 .°. ix
Sig lure of responsible appiicant
Remarks i i,�s`rl� ���-� c� � �- "`t z°
-% ,' A 94 L-5 ® P % / ' '1.. ~ .P.- i'ArAv V '"
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'� i S ( 1� i 'Cut # nz #l�ttlitorr } M =_''. - 1 ,
� Fil ( r i ! ) R , ' m 3 f ass>rchusrtts =E
` 2 3 E �RTMENT OP B INSPECTIONS _ : r`_ .- •
INSPECTO' t?EFT OF SUrL,; ,� 2 2 Main Street • Municipal Building �' o, 4
- Ttt }f1S Northampton, •
MA 01060
INI
I Applicant Information
Location * '' 4-tr -..-
City -- — - -4 f —`� — -- 3'l_ C,/6ci —
❑ I am a homeowner performing all work myself
---- -F t a sole proprietor and have no one working in any capacity
f3;' a »ta gz. 4:;ittift %? hih fit avFt#e�""si� taff:S` . ,o5 'escas rrz•,vftg.. ZK?w.s;x •t, :et trgw..'4' I_ -t-n :',aY's
❑ I am an employer providing workers' compensation for my employees working on this job.
Company Name - - - - -- - -- - - -- — --
Address - - -- - - -- — - -- ----- - - - ---
Ciiy -- -- — _ - - - - -- _ Phone #-- - - - - --
Insurance Co._ - - -- - - - - - -- Policy # - - - - -- - -_
:.itJ -; `yiit... =,..- . •: ."... �`�. . 5z:' 9w4t}( givits}''✓it4;R�:w•A. •'f:�1'.5y„, 'Y. h C v,e. i:YYwFp. eti
Company Name
Address
City Phone #
Insurance Co. Policy #
!1y!.t.0,iwLY4s.m.:1,LietR....v s...:'k.'`.uwar Ciele,!' wolur.e. 'FAR{'Swa4A!3:eak omh' V4e. siitt: i•: �i�A. i ii' t3. A oP. i!• #ti:daRt?+:.vout..4rS'.'C{ °+
Failure to secure coverage as required under Section 25 A of toIGL 152 can lead to the imposition of criminal
penalties of a fine up to $1500.00andlor one years' imprisonrnent as well as civil penalties in the form of a STOP
WORK ORDER and a fine of $100.00 a clay against me. I understand that a copy of this statement may be
forwarded to the Office of Investigations of the DIA for coverage verification.
y certi . r,er e pairs and :•n, i•: of perjury that the information provided .4ove' true and correct.
/.J iii ,„ iV/ i
Signatu • _ Date -- /
Print Name /G _ //� P 1 l_5,0" — 7 ?0 V.7�-
t 4 \
Official Use Only Do not write in this area to be completed by city or town official
City or Town PermitiLicense yf ❑ Hu}7dinc Dept
❑ Lkensint Board
Check if immediate response is required ❑ Selectmen'
Contact Person Phone It
9 Health Dept.
. t:
•
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 column to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - front
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
# of - Parking Spaces
it of Loading Docks
Fill:
-( volume -& location)
•
13. Certification: I hereby certify that the infor . '.n contain -: erein
G is t # - a/ accurate to the best of my know -dge.
DATE: _ ' z , APPLICANT 's SIGNATURE ,,,,,a1M A dr, /' o
NOT is an - of - zo ng permit does not relieve an app#foant's bur- en to comply with'all
zon' g - - ui ements and obtain all required permits from the Board of Health, Conservation
Co salon, Department of Pubiio Works end other applicable permit granting authorities.
FILE
?
i File 1s1 .1 I v ` � I
JUL 2 3 1999 ' , y � '
ZQN'NG PERMIT APPL CATION ( §10.2 )
DEPT OF NU ,;,,I,
a �.- -. ';.�.E, __�._ , 9 ,'LEAS`._ - - 'E OR PRINT T, FORMATION
1. Name of Applicant: _ ,J // id D - 037
Address: , � 0 r , ,'" elepho /
_mow ?
: a / 7 - S
2. Owner of Property: _ AO / / lie /
Address: :5� ��� / e � � . t e phone: l � • yz
3. Status of Applicant: Owner Contract Purchaser Lessee
Other (explain): . i
�J , . • % Amor
4. Job Location: �� �i �s -0 � ''
Parcel Id: Zoning Map# Parcel# 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):
—e ^ , iii. i 7-"t- w �4 i oymrser_jamv
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 PermitNariance/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)
45 GLEASON RD BP- 2000 -0089
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18C - 103 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: roofing BUILDING PERMIT
Permit # BP- 2000 -0089
Project # JS-2000-01 38
Est. Cost: $6315.00
Fee: $20.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT D THIBODO 1 18441
Lot Size(sq. ft.) 7143.84 Owner: MIROSHNICHENKO IGOR A
Zoning: URB Applicant: ROBERT D THIBODO
AT: 45 GLEASON RD
Applicant Address: Phone: Insurance:
P 0 BOX 201 (413) 527 -8966
NORTHAMPTON 01061 ISSUED ON:7/23/1999 0:00:00
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 Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 7/23/1999 0:00:00 $20.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo