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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location /Jam' �O 7, 's ��z. Lot No.
2. Owner's name—& Address l6 Xn ee",4 11,0 .f %a
3. Builder's name `Y��� � >� ,¢,.�AT Address
Mass.Construction Supervisor's License No. OHO // 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
10. Method of heating
11. Distance to lot lines
12. Type of roof �J -r
13. Siding house
14. Estimated cost-
The undersigned certifies that the above statements are we to the best of his, her
knowledge belief.
VP
Signature of responsible app,icant
Remarks
t l 1
s a OCr ialz# nt}� �rr
rY 5l u xsartchnsctta
DEPdAARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060 yV
WORICER'S COiYLPENSATION INSURANCE A t t AVTT
• (li c.�nserJpermi tree)
vnth a principal place of busioess/resideric�e at:
� Z-YC
(stre~t/city! zip)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my .
employees working on this job.
�W7-1a,641 GA �:25
(lnsuranee Company) (Policy Number) (Expiration Date)
( 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:
t /A �e 4 U"'G
(iNamc of Cont-,actor) (Insurance ComDam;,/Policv Date)
(Name of Colltnctor) (IlLSUranc Comoau"-/Po!icr Number) (Expiration Date)
(Name of Contractor) (Insurance CompanylPol;•cy Nurnbu) (Expvabon Date)
(Name of Contractor) (Insurance Commny/Policy Number) (Expiration Dale)
(attach additicoil sfx if ncccauy to i dut}c inform ct pertlining too U coc,, C -3)
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 aw-trc that whrdo hoa)couocrs tvho employ persom m do MaiUtCaIaCr,eoastruc6ca'or repair worst oo a dvrell g of
not moco than throo units in wdtich the honxotivncr r=,Ac,or oa the grounds appurtc*•E�t thact°arc not gencrz ooeridcrcd w b:
employers under tbo wockct's cempc 4ca Act(GL152—"1(5)),applica-6on by a homeowner for a liecnlc oc permit may evidence the
1cga1 cistrra of an omployor under dw Wockvex CompamAtioa Act
I understand thsd a copy of this mtcmcut may bo forva-wdod to the Dcq,,cOOnt of Indium al q.ocidonA.'O12ioo of Imvrwoo for Ihs
oovcng verification and that failurc to sca=coven%-a under section 25A of MOL 152=lead to the iurposibOa of criminll pca+ltics
comistiog of a fine of up to S 1 500.00 and/or imprnoauxsrL of rip to one yvr and civil p.lties io the form of a Stop W ofk Orda and 1 1
fim of 5100.00 a clay-Pint ma
For is mun-w uao°city
Permit Ntunber'
P#, Lot# t
S hui of LiacnscrlPcrmiticc
Ile � %-1,C c, %I F-7J',
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 coluam 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
&paced parking j
# 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 knowl
D 7 21 E: 4, " _ APPLICANT's SIGNATURE /�-
NOTE: lasuanoe t a zoning permit does not relieve an pplioanYs bu den to comply with .plt
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commisslon, Department of Publio Works and other applioable permit granting authorities.
FILE #
�+U1, OCT 1 5 1998
_ Fi 1 e No.
tt �Ei i t� 15"7"-1_6 r G i�av?rCTION'S
PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: 2-7 Telephone: 1�-
2. Owner of Property: �/ � � &1&1:2 f
Address: 6�ti •!c�e_ �• TG'/5� Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: C`'^�+ �+ ����✓e� ate,, ' v TUXI
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUI DING DEPARTMENT)
5. Existing Use of Structure/Property S ,¢/zl'aG A_
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
e.
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 e' 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 y 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)
r
File#BP-1999-0398 r
APPLICANT/CONTACT PERSON isfmg `��"" ` .�0� 7" t f
ADDRESS/PHONE 17 1/2 Briggs (413)529-0170 2
,J-17,J-17 I
PROPERTY LOCATION 119 FLORIDA AVE O
MAP 32C PARCEL 151 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT `.�
Fee Paid
Building Permit ' led out
Fee Paid _u
Type of Construction:
New Construction
Non Structural interior renovations
Addition to Existin¢
Accessory Structure
Building Plans Included:
Owner/Occupant Statement or License#
3 sets of Plans/Plot Plan
TH OLL
OWING 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 Board of Health Well Water Potability Board of Health
Permit from Conservation Co i�aion
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
Department: Reference No: BP-1999-0398
..............•....................
Building,Electrical & Mechanical Permits
Fee Receipt No:
demolition REC-1999-001012
P.aia.B.y:.......................................................................... Paid. i.n.Full.......-••
0 n:..........
Paul Truehart Thu Oct 15,1998
...• ...... .... .. . ...... ............
Received..By.: .Check. . .No:...................
Linda Lapointe 683
......................................................................................... .•.•.•..........•.•.......•.••.•......
DEPARTMENT'S COPY Amount: $40.00
...........................
DEPARTMENT FILE COPY 119 FLORIDA AVE
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:
BP-1999-0398 $40.00
GIS #: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
6620 32C 151 001 119 FLORIDA AVE URC 13808.52
Contractor: License Type: Insurance:
Paul Truchart CSL
Address: License No.: Insurance No.:
27 College Highway 060511
Li!n State: Zip Code: Phone:
SOUTHAMPTON MA 01073 (413) 527-9246
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1998-0019 demolition $1,000.00
Description of Work:
DEMO GARAGE
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: