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Zoning
Miscellaneous Additions, Repairs, Alterations, etc. Tel. No.... Alterations
% r. NORTHAMPTON, MASS. /6 Mo 1 9 Additions
r '%4' APPLICATION FOR PERMIT TO ALTER Repair
g
�� Garage
1. Location e ..3S- ..3S- ,F /o( ') cc /g " fr/o,eLt » c t Iii LA.- Lot No.
2. Owner's name 7 i D/215 G i 11 / Address 6 3 6 7 T G cE £.f ./" (04Z C, ds 4�
3. Builder's name F a d 5/'/A) G' � � � ? / . 7-1--c. " Address ? / /g2 4 ,e .4/0 44 !Om �
Mass. Construction Supervisor's License No. O 4 ? y� Expiration Date 0 — g45" a
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 /
13. Siding house /0// N l r -/''/ / jO �' `' le ( " r /U' ! da-
s�
14. Estimated cost- $ 7,5 0 4 -%
i
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
, L
Signature of +esponsible applicant
Remarks
•
#. MAY 1 51998 (!i it cif Tax Ijitt�Ityy�y nrr _ ** � •
9 ����� ?� d .asartclinsctta _ " t _
,st — ed. Flt OF ;-,r T ,r. _
T' �� ' DEPARTMENT OP BUILDING INSPECTIONS __� •
_. 212 Main Street • Municipal Building o
Northampton, Mass. 01060 y IS "'
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, 7354 /'- _s,,9, C r — Z11) c
3 (li censedpelmi ttee)
with a principal place of business/residence at:
r &l cl 99 �Ge9AU 44, (14 2 A1 "14 ( phone # age `f 6
(s17 st ate/ap)
do hereby certify, under the pains and penalties of perjury, that:
( �I am an employer providing the following worker's compensation coverage for my
P g P $
employees working on this job:
'r1S A) S0ft / ri 1�'S CO /00o a a go 45 -? 7
(Insurance Co m.. • ) (Policy Number) (Expiration Date)
( ) 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) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company /Policy Number) (Expiation Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(fa ach additioml :#wi if neceicary to include information pertaining to ell cow actors)
( ) 1 and a sole proprietor and have no one working for me.
( ) 1 am a home owner performing all the work myself.
NOTE: plat= be aware that whilo homeowner, wbo canplay persona to do mai*TtMaIIM, coasruction repair work on a dwelling of
nor moco than iheoo units in which the homeowner rrxidca or on the) grounds appurtenant thereto are cot gcocralty coasidcred to be
cmployers under tbo w ockeel cecoparszticxx Act (GL152,33 1(5)), application by a bomcowncr for a license a peanut may cvidcnoe tbo
legal status of an employer under tho Woric ea Cocapcmation Act_
I undcntaud that a copy of this b:romt may bo forw arded to the Dcpertmcot of Incdutriel Amdca& OfSoo of In,ur.coo for the
coverage vcrificaiioa and that failure to accure covcrago under section 25A of MQL 152 can lad to tbd impolittoa of criminal pcaaltia
of a-fmc of up to 51„500.00 andfcc imprisonment of up to Doe year and civil pm:attic, in the form of !taco Work. Order and a
find of 5100.00 a day against tnc.
For departmeobtl tun Doty
--'" Permit Number
I , / g __ _ Lot
.< : . Sigiiatirre of Licen� nee
r >
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 - frnnt
- side L: R: L: R:
- rear
Building height
•
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
# of Spaces
f o
# f Loading Docks
Fill:
-( volume _& location)
13. Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
DATE : /�N� �-G 9 APPLICANT 's SIGNATURE a� -e
NOTE: Issuanoe of a zoning permit does not relieve an applioants burden to oomply witty ill
zoning requirements and obtain all required permits from the Board of He th. Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
FILE
L7
I MAY 1 1998
File No. /.
P /�
9f! 55 7"6
PERMIT APPLICATION ( §10.2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: /391--/e �,�'te� �G � G - e6' //I,i) 64'01
Address: 791 % ,�i � PeP /I/C�gif4�Prr7 ) Telephone: 5 W47
2. Owner of Property: m DR' SC b /r
Address: t 35 /O .e)C t ��9 f '..& lifg Telephone: 5 "Ft4'
3. Status of Applicant: Owner Contract Purchaser I/ Lessee
Other (explain):
4. Job Location:
Parcel Id: Zoning Map# 3 7 Parcel# / District(s): 5
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5 Existing Use of Structure/Property SR
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): •
VI N // 6/6 X -" „” lt) ti ewe e c
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)
ni /59 FILE # t'
MAY 1 5 1998
APPLICANT /CONTACT PERSON: io , ,,��� v� 6.)
y -5/ i 7
F DRESS/PHONE: `71/ di f .
PROPERTY LOCATION: tit 3 7 'i
MAP 3 2 PARCEL: ZONE
PHIS SECTION FOR_OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FTT ,T ,FT) OUT ../
Fee Paid
Rnilding Permit Filled nut
Fee Paid A 0: ✓
New Cnnetrnctinn • -64e
Remndeling Tnterinr
Additinn to Exieting /�i�(L .t'�-Gr�YVI[��it
A cceeenry Structure ✓
Rnilding Plane Included• t
Owner /Occupant Statement nr T, cene) 0�GaeT �
3 Sete of Plane / Pint Plan
Approved 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 -Bd of Health Well Water Potability -Bd Health
Permit from Conservati ommission
.20/,4
Signature of Buildin • .. sector Date
NOTE: Issuanoe of a zoning permit does not relieve an applicant's burden to oompty with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Worics and other applioable permit granting authorities.
Department: Reference No: BP- 1998 -0009
Building, Electrical & Mechanical Permits
Fee Type: Receipt No:
Roofing REC 1998 - 000012
Paid By: Paid in Full On:
B & R Siding Wed May 20,1998
Received By: Check No:
Linda Lapointe 16029
DEPARTMENT'S COPY Amount: $20.00
DEPARTMENT FILE COPY 635 FLORENCE RD
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: 1 5q ( Inspector: Tracking No.: Fee:
20 May, 1998 BP -1998 -0009 Stanley Szewczyk 963540 $20.00
GIS #: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
7378 37 012 001 635 FLORENCE RD SR 26789.4
Contractor: License Type: Insurance:
B & R Siding
Address: License No.: Insurance No.:
781 Bridge Rd.
City: State: Zip Code: Phone:
NORTHAMPTON MA 01062 (413) 586 -4167
Project No: Category of Work: Const. Class: Cost Estimate:
JS- 1998 -0011 $7,500.00
Description of Work:
Install vinyl siding and replacement windows
GeoTMS® 1997 Des Lauriers & Associates, Inc. Signature:
CITY OF NORTHAMPTON
BUILDII\G PERMIT
ROOFING - WINDOWS & DOORS -
SIDING
635 FLORENCE RD , Map 37 - Parcel 012
Fee $20.00, Applicant B & R Siding
963540 BP- 1998 -0009 /5 `q I JS- 1998 -0011
Date issued 20- May -1998
- -- Building Inspection -
Rough
Building Inspection -
Finish fr; . 7- 2 SA — 48
Approved by _ -� ,f ; _ , %-
•
d 1 ding o
This certifies that B & R Siding has permission to ( Install vinyl siding and replacement windows) , situated
at 635FLORENCE RD , provided that the person accepting this permit shall in every respect conform to the
terms of the application on file in the office of the Building Depai tinent, and to the provisions of the
Statutes and the Ordinances relating to the construction, Maintenance and Inspection of Buildings in the
City of Northampton. Any violation of any of the terms above noted is an immediate revocation of this
permit. Expires six months from date of issuance , if not started. All installations of windows, siding,
roofing materials and doors shall be to manufacturer's specifications.
The contractor is responsible to hire a licensed electrician if the removal or relocation of any
electrical lines or fixtures is required for installation of siding products.
.
I r
R6lilding Department