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29-401 *r . > Z 70 'p 00 3 O Z m O) c n .b -- C, -� m t U J o CrJ :0 Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations 4aNORTHAMPTON, MASS-2�T -2157 Additions APPLICATION FOR PERMIT TO ALTER Repair Garage 1. Location Lot No. 2. Owner's name L u ^���i y�r+/ Address S'A . 3. Builder's name CZ�'f C U� �T� Address Mass.Construction Supervisor's License No. ®607 Expiration Date 4'3©- Zck�-::b 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 s 12. Type of roof ,S'TJ�'�r°}�!>a�i /� - S ��✓s t� 13. Siding house 14. Estimated cost:- The undersigned certifies that the above statements are we to the best of his, her knowledge and belief. Signature of responsible app,icant Remarks 1 � •�0 AL"kalP O o B 9 Grxt� Of 'Warf �111�J�II1I f � � �zsaxcEinsrtfa m �U►LDj G 1v1' EfIi�i a DEPARTMENT OF BUILDING INSPECTIONS � NoRFfNkWT0y �,A 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORKER'S COI1ITENSATION INSURANCE AFFMAVIT (h censcrJperm1 ttece) with a principal place of business/residence at: f (�rt`d> W O MV/ (phone#WTC1__ ciap) do hereby certify, under the pains and penalties of perjury, that ( } I am an employer providing the follo`ving •,vorker's compensation coverage for my employees worming on this job: (insurance Company) (Policy Number) (Expiration Daze) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compen-sation policies: (Name of Contractor) (Lastiranc—_ Company/Policy Number) (ExT rm6on Date) (Name of Contractor) (lDsurancz Company/Policy Number) (Expiration Date) (Name of Contractor) Qnsuranc�t Compa-ay/Policy Number) (Ea-pimbon Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additiocul sh,c ifmc�ccsszry t�6d,, c information pertaiaiag to all corn-cion) (Vj I am a sole proprietor and have no one workdng for me. ( ) I am a home owner performing all. the work myself. NOTE:plcasc be awrrc that whilo homC0AMM wbo cinplay pCr- n=to do •j*[+�coastnutioa or rcpau Worir oa a d­jling of not mo"than tbroo Um in which the hoawwacr mid=<x oa the gioun,ds appttrteoaut th=to arc oot wally ooasida-cd to be cmployaa under the WOO k 4s 03MP=5ei0n Art(GL152,=1(5)),application by a homcoavcr for a license or pamh may evidrncc tho legal eistua of am amployer undor tho Wortco�a ComspCmat_ioa Act I understand tbai a oopy of thin o tc may bo foryvrdad to the Dcpartmcot of 1�&u d Aoci&a&Offioo of[n3u amoo for the covcrxge vaificatioa and that failure to soatrc a vcc undct section 25A of MOL 152 an lead to the impoutioa of aiminal penalties -=t mg of a fine of up to S 1,500.00 andlor of tip to one yar and ci pcm hies is the form of a Stop Work Order and a 5>m of 5100.00 a day agaimi me. - Foc dcparta>=1 tiso only Permit Number Date Lot# Signa�0-.Li ermittcc 10. Do any signs ebst 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 cols to be filled 1. by the Building Department Required I Existing Proposed By Zoning Lot size Frontage Setbacks - 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. D?II'E: APPLICANT's SIGNATURE_ NOTE: Issunnoe of a zoning permit does not relieve an applioant's burden to oomply with .4111 zoning requirements and obtain all required permits from the Board of Health, Conservation Commisslon, Department of Publio Works and other appiioabla permit granting authorities. FILE # allo' v� ��� �� � � 21VING ���==� �=� =�==����=" v ���� . �� PLEASE TYPE OR PR1WT ALL 12TFORMATION 1. Name of Applicant: ��u~r Address: 2. Ow fP Address: 146610; -5ZAIVe- Telephone: 3. Status mfApplicant: Owner Contract Purchaser Lessee Other(explain): 4. Job Location: Paroeild: Zoning Map parce| District(s): (TO BE FILLED |N8Y THE BUILDING DEPARTMENT) x 5. Existing Use ofStructure/Property ~- 6. Description of Proposed Uso&Work/Project/Dccupation: (Use additional sheets ifnenesmory): 7. Attached Plans: Sketch Plan -Site Plan ngineemod/8unx»yedP|ana Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files. 8. Has o Special Perm hA/ahonoe/Finding ever been issued for/on the site? NO DON'T KNOW YES [F YES,date issued: IFYES: Was the permit recorded at the Registry ofDeeds? NO DON'T KNOW YE IF YES: enter Book Page and/or Onnunnmnt g' Does the site contain a brook, body of water orwetlands? NO DON'T KNOW YE IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs toba obtained Obtained- .date issued: (FORM CONTINUES ONOTHER SIDE) Reference No: BP-1999-0350 Department: ................................... Building, Electrical & Mechanical Permits Fee Type: Receipt No: Roofing REC-1999-000917 Paid By: Paid i n Full 0 n Ed Corbett Jr Fri Oct 02,1998 . .... ....... ................... .................Received By: C h eck . No:................... :Linda Lapointe 2885 ......................................................................................... ...............•.•.•..••.............. DEPARTMENT'S COPY Amount: $20.00 ........................... 1)EPARTM.ENrr FILE COPY 68 SANDY HILL 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: Inspector: Tracking No.: Fee: 02 Oct, 1998 BP-1999-0350 $20.00 GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size: 5124 29 401 001 68 SANDY HILL RD URA 11891.88 Contractor: License Type: Insurance: Ed Corbett Jr HIC Address: License No.: Insurance No.: 4 Reed Street 116069 City: State: Zip Code: Phone: NORTHAMPTON MA 01060 (413) 584-6571 Proiect No: Category of Work: Const. Class: Cost Estimate: JS-1999-0719 roofing $5,200.00 Description of Work: STRIP & SHINGLE ROOF GeoTMS(E)1997 Des Lauders&Associates,Inc. Signature: