32C-292 -'tt 3 C
Omi-
s 70 m
ti t N O >
cD _w r Z m
'-1 r
ft
r v 0
a �
Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. �' / `'- /' <- 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
a
Garage
1. Location �/ L �C - / / Lot No.
2. Owner's name �� 1 C Y At- "I I /t Address l `l �2,11 rZ-' 7-
3. Builder's name t ,') a!, Address % ��t r<'e >a ,
Mass.Construction Supervisor's License No. 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 S V t�r4L
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are we to the best of his, her
knowledge kand`beliF`—
Signature of responsible app,icani
Remarks
AUG 2 811998 ¢' xssR�hns<«s
m
DEPT OF UT DEW- MENT OF BUILDING INSPECTIONS
N OR TH',a� ltd 3 N st``'n -Main Street e Municipal Building '
Northampton, Mass. ' 01060
WORKER'S CONi MENSAITON INSURANCE AFFIDAVIT
(li censce/permi flee)
\vith a principal place of business/residence at'.
2 Le L,�2 ({L (phone#) W- Y1 &5
(str�i/c1 ty/stalrla p)
do hereby certify, under the pains and penalties of pegury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job.
(ins>lrancx,Compauy) (Policy Number) (Expiration Date)
1
O 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:
(Annie of Contractor) (Ln-,zi=cc Corn aay1Policy Numk-,) (Ex-niraCon Date)
(N-amc of Contractor) Jnsurance CoznnUiti•iPotic; Nttrncer) (E�:pirntion Date)
(Name of Contractor) (Insuranc Compauy/Policy Nutnbu) (Hxpirabon Date)
(Name of Contractor) (Insurance Compaily/Policy Number) (Expiration Date)
(attach additicoil zhect if nxczury to nclu Sc infomixt ca pctai.-zinsg to all coctra,-'ore)
( am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be Swart that wb„to homcoµncn«txh auplay pcnous to do mxiri • 00cmrud60a'or r=Pair worst on s dhvclling of
not mot'o than throo tutus is which the homoou ncr residca or on the groua is appurtenant tlac^cto arc not ecsxxalty oowukrrd to be
employrra undo the worker'%oempcisalien Act(GL152,s31(5)),n-Wd bon by a homcowar for a lease cc permit may evidence tho
legal euahhs of an employor under the Woricer't Compcm-L i Act
I undcatand that a copy of this ctatcmmt may bo f x—uciod to tho Dcpnrtxncal of IndauIIia1 Ate&Offioe of Inzur..neo for the
covcragc vrrMcatioa and that failure to secure oov c%- under scetioa 25A of MOL 152 can lead to the'imposition of criminal pcaaltia
eom fisting of a fine'of up to S1,500,00 anNor iznprisosanent of up to one ycr and avil pcmltia in the form of n Stop Work Order and a
fwn of 5100.00 a day t81 ?tnc
For&P=tarntal uao only
Permit Number
l J7 Iviap:� Lot# ,
Signature of'Liccnsce/Pennitice ;
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 COMPLE'T'ED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This —7== to ba 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 parkingi
# 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 kn 1e e� —
DATE: d APPLICANT's SIGNATURE ��
NOTE: Issu no® of a zoning permit does not relieve an applioanYs burden to oom wit -
zoning requiraments and obtain all required PIY I� .ell
q permits from the Board of Health, Conservation
Commission. Department of Publio Works and other applioabla permit granting authorities.
FILE #
E �J
i
AUG 2 8 1998 a a
T
File No.
iuF -r
. DE F�° � ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: `L �l c �2( S Telephone:
2. Owner of Property: G%% C y A- /1-?.14zle r
Address: Li %t Telephone: 5-- G 7 2-
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): Co L4 I C- �
4. Job Location: I L/ S/
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property L yr- fc y
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
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 YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 4--" DON'T KNOW YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NQ,/ 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)
Reference No- BP-1999-0245
Department: ..............•.•.•.•••.•••........
Building,Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Roofing REC-1999-000534
... .....................................................................................
Paid By: Pa.id.i.n.F.u.I.I..On:
David Fortier Fri Aug 28,1998
.........................................................................................
Received By: ......................................
Check No:
Linda Lapointe 2618
................ ........................................................................
...................•..................
DEPARTMENT'S COPY Amount: $20.00
...........................
DEPARTMEN,r FILE COPY 14 VALLEY 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(MGL 142A)
Issued: Permit No: Inspector: Tracking No.: Fee:
28 Aug, 1998 BP-1999-0245 $20.00
GIS #: Man Block: Lot: Address: Zoning: Use Group: Lot Size:
6735 32C 292 001 14 VALLEY ST URC 13198.68
Contractor: License Type: Insurance:
David Fortier HIC
Address: License No.: Insurance No.:
32 Laurel St 103999
City: State: Zip Code: Phone:
NORTHAMPTON MA 01060 (413) 586-8965
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0457 roofing $7,000.00
Description of Work:
STRIP & SHINGLE ROOF
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: