32C-151 (7) w j 'd c
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A Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. �i 2 t 000 Alterations 574 r Additions
NORTHAMPTON, MASS. .^? 19
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location t / ''" Lot No.
2. Owners name r✓0 1y\ FOO-T MT C f AYV I ItL Address
3. Builder's name, ig-fl?? 0 Address_ t'2 11 OR 5'x,
Mass.Construction ction Supervisor's License No. ® � Expiration Date �SLy 9'
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�15�1$ LT
13. Siding house
14. Estimated cost-
The undersigned certifies that the above statements are true to the best of his, her
�� C> knowledge and belief.
Sign. re of responsible app ican!
Remarks G yil2
4�11AM P�0
0
goo Y MAY 2 I ; zi xafaz#C�tt�lttun ^
lulsac4nsctIs
m t F'T OF 1`si :DLIFAR7-MEN-r OF BUILDING INSPECTIONS
••212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORT ER'S COMPENSATION INSURANCE AIMAVIT
(licenser/permittee)
with a principal place of business/residence ati
(strceuci ty/stalfj2ip)
do hereby certify, under the pains and penalties of penury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job.
(Insunrce Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired
the contractor2 listed belo^ vr who iiave. the tMovvr'mg workerrs mmpensauo n policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (lnsurancc Company/Po[icy Number) (Expiration Date)
(Name of Contractor) (Insurance Compaay/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(stlacb addi600al sbtct if notxuary to include inform tion pest imng to all o�n)
`-A am a sole proprietor and have no one wonting for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aw-4m that wbilo homeowner who ernplay pasom to do n& t=3zcr arnsfru oa or rcpa.ir work ou c dwelling of
not mocn than tbtu units is wlvch the bomooavcr midca or oa the grounds appurtcnaat tbacto arc not gcoaally comidcrcd to be
employ=under tho worfca`s 0omps4ca Act(GL.152,ss 1(5)�applimfioo by a homeowner for a license oc pamaH MaY cvidcrrc tbo
kpi tuh, of an omployor undor tho Worlcce&Compo.s�Act
I undastaad tivd a copy of this sSnl.cmcai may bo foaward.ed to tho Dtpartmcot of rndusaricl Accidrnt>'offs o of Ianrriooa for tbo
coverage wrifscatioc and tbat failure to&-titre eovcmv under soction 25A of MGL 152 cin lead to tba imposition of aimi'14 penalties
ootnisimg of a fnc of up to S1,500.00 tmdroe imprisoomrnt of tip to one year and Civil pmsltica in the focm of a stop Work Order and a
firm o[5100.00 a day a gn.inst ma
Signed this day Of7?- 199V Foracpumx3alu,00aly
Permit Number
!� Map4— Lot#
SignahucofLilP
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 coin= to be filled im
by the Building Department
l Required 1
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 parkingi
# of -Parking Spaces
# of 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: 2l APPLICANT's SIGNATURE `
NOTE: gas u no of a zoning permit does not relieve an applicant's urden to oompiy WIt4 4111
zoning require. ants and obtain all required permits from the Board of Health. Conservation
Commission, Department of Publio Works and other applioabla permit granting authorities.
r
FILE #
f `ii
? ' MAY 2 1 11998 Fi1e No �
u
l "'ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: . ff��/ `GAOf���- G
Address: 61 0 6 %J Telephone: 7(V
Is m ort
2. Owner of Property: 1C _Claim `"—
Address: 5-A7V Q`/ -PAA-0 -5 Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
/Other(explain)-
4. Job Location
Parcel Id: Zoning Map# i Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
r
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
L2,OCR r`= 171-6 A–U (f'U � t�
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.
S. Has a Special Permit/Variance/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)
i
n ,F FILE #
MAY 2 I 1998
APPLICANVCONTACT PERSON: C Qf 6_1
0EPp�� 3D SW Nt: / >
!Y17S 3 S
PROPERTY LOCATION: — a
MAP PARCEL: _ ZONE
THIS SECTION FOR.0FFICIAL USE ONLY:
PERMIT APPLICATION.CHECKLIST
ENCLOSED REQUIRED DATE
Fee Pnid
Rididin2 I!ermit MUM 011t
Additinn to Existing
Stritetitre
TVOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
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
�pj�tIkPp�c}Y1� d peal Well Water Potability-Bd Health
!Permit from Conservation mmission
.S Z ;A?
Signature of Building or Date
NOTE:Issuanae of a zoning permit does not relieve an appiioant's burden to comply with ail
_ zoning requirements and obtain eill required permits from the Board of Health, Conservation
Commission, Department of Public Works and other appiioable permit granting authorities.
Department: Reference No: BP-1998-0018
...................................
Building, Electrical & Mechanical Permits
...................................................................................
Fee Type: Receipt No:
Roofing REC-1998-000021
..........................................................................
Paid By: ......
On:• •P-•• •• ••---•-- - ....
aid in Full On:
DE Sheppard Roofing Tue May 26,1998
............... ...............
. ...... ....•
Received By Check. .No:
Linda Lapointe 1247
..--•..............................••--•---•--••--••---..................................
......................................
DEPARTMENT'S COPY Amount: $20.00
...........................
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:
26 May, 1998 BP-1998-0018 Stanley Szewczyk 963564 $20.00
GIS #; Map Block: Lot: Address: Zoning Use Group: Lot Size:
6620 32C 151 001 119 FLORIDA AVE URC 13808.52
Contractor: License Type: Insurance:
DE Sheppard Roofing
Address: License No.: Insurance No.:
17 1/2 Briggs
City State: Zip Code: Phone:
EASTHAMPTON MA (413) 529-0170
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1998-0019 $3,550.00
Description of Work:
Strip and Re-roof
S®1997 Des Lauriers&Associates,Inc. Signature-