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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. AA Tel.No. Alterations
�4. NORTHAMPTON, MASS.
Ju10 19 FIR Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
;�
1. Location ! 1 Si ' )� ` Lot No.
2. Owner's name rl . .I�er Address RO c—A -
3. Builder's name NS 1 ' 10a- eut) Address '33 6440� 1 p e 'C1 e Mil-
Mass.Construction Supervisor's License No. L-S G 53 1 7 7 Expiration Date I t, I 1 /9 7
4. Addition
5. Alteration A) fir-'
6. New Porch
7. Is existing building to be demolished?, A)O
8. Repair after the fire Ai 6
9. Garage N c No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof S A\L F' CVO e'N
13. Siding house
14. Estimated cost:- (.0 0/601.)
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief. �..
?e`
Signature o<rer nsibis appiscant
Remarks
Ewa:
aq� '199b Cris lafzlxttrlttan I -*
,. -- ,jt'�l� MAY 2 8 �� _- "
9�•�i �,�� Sass:xdinsctta -'= =
e y'' DEPARTMENT OP BUILDING INSPECTIONS 4
212 Main Street ' Municipal Building
Northampton, Mass. 01060 twos
WORKER'S COMPENSATION INSURA_NCE AFFIDA.VrT
■
// tip — A .. _ C-
(li censtclpenni ttce)
with a principal place of business/residence at:
70 0/ /!GA" 577 G ��ic-�/z- rrA.1'//�//(Phone#) '.-s�3�-e
(strut/cit staidap)
do hereby certify, under the pains and penalties of perjury, that:
(,1'S I am an employer providing the following worker's compensation coverage for my
employees working on this job:
'4f .1 ,,y / C 3?8' o,- �/_
. ..ce Company) (Policy Number) (Expiration D'are)
( ) 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) (Innirancc Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
•
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional:hcct if noc x y to incn,do infocmiboa pcs-taarang to all coat actors)
( ) 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 aware that while homcowocro wbo employ persons to do rm.hrt,,,,,,-,-,construction-or repair work on a dwelling of
not mops than throe units is which the bogxowncr reside or on the grounds appurtenant thereto art cot geoerarly co:slid:rcd to be
employers under the worker's.c prnsaticn Act(GL152s_i 1(S)),application by a homeowner far a liecr sc oc permit may cvidcaoc the
lcgir ctahse of an employe(undertho Woriecer Coospcmation Act
I understand that a copy of thia ecatement may bo forwnnied to the Dryuuncot of Industrial Aoadoats OtSoo of Imuraoce for the
coverage verification and that failure to son=coverage under section 2SA of MOL 152 cart lead to doe''°'oaition at-criminal pmaltics
eoaustiag of a•fine bf up to SI,500.00 andlor imprisonment of tip to one year and civil penalties in the form of a Stop Work.Order.and a ,
Sao of 5100.00 1 y agniast too.
For dcpatmr�al ciao onty
/ -r.:-.-,,,,,,,..k).1) ' . f.,,,,e I, ,,,, - , - -.3..., :.--. lz.,,,....-.._—,-, .,......ick-).;:.-:-!...L-L,___, ,
sigi shirt of Lii cnsalP
:. .. .: .
5
10. Do any signs exist on the property? YES NO
IF YES,describe size,type and location: 44A,
CAvL
Are there any proposed changes to or additions of signs intended for the property?YES __ NO X
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 Parking Spaces --
# (of Loading Docks
Fill:
-(volume -& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: : 124/fY
A CA s SIGNATURE
NOTE: lea anoe
of a zoning permit does not relieve an applioent's bu d� en to comply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applioable permit granting authorities.
FILE
•
�Y File No. 933 /
Lp
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1.( Name of Applicant: ENS Q Y✓✓vw0
fin A: IV
Address: 33"7 7 c0 L Telephone: �/3 71 `ak".S
2. Owner of Property: Iv`■3A-� t 5 4 550C
Address: 4 s U L ck Ji 4ii0 )(0 Telephone: 11/? 5 `5C O a /Y.
3. Status of Applicant: Owner _Contract Purchaser Lessee
Other(explain):
4. Job Location: 1}L.01-44--° St
Parcel Id: Zoning Map#,,3 113 Parcel# District(s): G� -
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property \A-66') i
6. Description olf Proposed Use ork/Project/Occupation: (Use 9idditional sheets if nec ss
1v, aii.)-bAsAD t 6 0— °A
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 X 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)
i FILE I l. a; ■ 6 I 7 :
MAY 28699b
APPLICANT/CONTACT PERSON-rAft az / haearlUfyiz, •3 36--A
ADDRESS/PHONE: - 6 r i. 4..._ / _ l _ ./.._./„. 0 0/3
PROPERTY LOCATION: 7%4te - 74 -d I Av We-r-(-4--te.--- ,
MAP erg"/5 PARCEL: 31t- ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION_CHECKLIST
ENCLOSED REQUIRED DATE
7.ONTNG FORM FTT.T,F.T? OTTT 1------
Fee Paid /
Rnilding Permit Filled nut yr,, ✓
Fee Paid 79 6 te2 1-----
Type of C'onctruetinn•
' New Construction
Remodeling Interior aP i
Addition to R.ricting
Accessory Strnetnre
Building Planc Included-
Owner/Occupant Statement n irence#� O ? 7 7 `------
3 Setc of Plans /Plot Plan
T OLLOWING 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
!P it fr Conse o• o l■.„�. on /'. °2 )--63
Signa e of Building Inspector Date
NOTE:Issuenoe of a zoning permit does not relieve an applioant's burden to comply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public" Works and other applioable permit granting authorities.
„ 318-k _sio
Department: Reference No: BP-1998-0035
Building, Electrical & Mechanical Permits
Fee Type: Receipt No:
Roofing REC-1998-000038
Paid By: Paid in Full On:
Titan Roofing Wed Jun 03,1998
Received By: Check No:
Linda Lapointe 7950
DEPARTMENT'S COPY Amount: $240.00
DEPARTMENT FILE COPY 71 STATE ST
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(M 142A)
Issued: Permit No: In._ Inspector: Tracking No.: Fee:
02 Jun, 1998 BP-1998-0035 Stanley Szewczyk 963591 $240.00
GIS#: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
9608 31B 310 001 71 STATE ST URC 90735.48
Contractor: License Type: Insurance:
Titan Roofing
Address: License No.: Insurance No.:
70 Orange St
City: State: Zip Code: Phone:
CHICOPEE MA 01013 (413) 536-1624
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1998-0036 $60,000.00
Description of Work:
install EPDM roof
GeoTMS®1997 Des Lauriers&Associates.Inc. Qi,nno*„ra•