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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER
Repair
� r
Garage
1. Location l_y E�� I i�- �� �r. — �C.,�E r"7 ' Lot No.
2. Owner's name -C U ;; r r-S( V—) Address j
3. Builder's name
�:, r� c_1, ,,t Address
Mass.Construction Supervisor's License No. C`, 1` ?_ Expiration Date
4. Addition
5. Alteration �� ( � 16-
6. New Porch
7. Is existing building to be demolished? V).U
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cosL-
The undersigned certifies that the above statements are wet the best of his, her
knowledge and belief.
Sig 'ture of respo sable app,icont`!
C 1 �
Remarks
•
�{ttAMp�, s
JLA- 1 '1998 Crxt� of art4ant p fnn
4
� � �iasaacE(trsrtts
m DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060 'V,y,
WORKER'S COMPENSATION MSURA..NCE AFFIDAVIT
(Ii censee/permi ttee)
with a principal place of business/residence at:
_> 1:�c ' (phone#) L
(street/city/sta&2ip)
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:
(Insurance Company) (Policy Number) Txpiratfon Date)
( ) 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) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/PoEcy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sixet if necessary to include infwmafion pataining to all eodrectom)
( ) 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 homeowners who employ person:to do o=stmction or repair work on a dwelling of
not atom than dm*units is which the homeowner resides or on the grounds appurtenant thereto are not gs n=4 oowkkred to be
employers under the wmkees compensation Act(GL152,ss 1(5)�application by a homeowner fora license or permit may evidence the
legal status of an employer under the Wortrer's Compamation Act
I understand that a copy of this statement may be forwarded to the Depumxol of IxkL-%rial A=dma Offloe of In=ane for the
coverage verification and that failure to segue coverage under section 25A of MOL 152 can lead to the imposdioa of M immai penalties
oomistiag of a fine of up to S1,500.00 andlor imprisonment of up to one year and civil p=arties in the form of a Stop Work Order and a
fuse of 5100.00 a day against me.
For dgnxtmLtal use oatY
Permit Number
Mao Lot#
ignatlue of Li et7n ttce
b�
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.
T2--v cOlw= to be filled im
by the Bnildiag Department
Required
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)
# o f 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 knowledge.
DATE: "-� l 0 APPLICANT's SIGNATURE
NOTE: Issuance of a zoning permit does not relieve nn-_.app ioant's burde to oom � wit 6 li'
e
zoning requiramants and obtain ail required permits from the Board of alth. Conservation
Commission. Department of Publio Works and other applicable permit granting authorities.
FILE #
af�
i99$
JUL I
File No.
o ®�
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION ll
1. Name of Applicant: {t-� , <� � �� M P �-
Address: (; � elephone:
c-
2. Owner of Pro e
V�
P rtY: --� � �1 � r� � i-'y�� r ._�C
Address: ��( C.�C�� c' ��; (�r Telephone: K
3. Status of Applicant: Owner �Contract Purchaser Lessee
Other(explain):r
4. Job Location: G/ 1 ,t > i� /('v('rl(
Parcel Id: Zoning Map# Parcel# /7/ District(s): �/�G�
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
D ]
5. Existing Use of Structure/Property _ i ��?`Pry 4- c' /
6. Description of Proposed Use/Vllork/P oject/Occupation: (Use add''o al seets if necessary):
cu-, I �� y� �(
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 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)
Department: Reference No: BP-1999-0001
Building,Electrical &Mechanical Permits
•.........................•-----•-•-•-----........-•---------------------------..........
Fee Type: Receipt No:
replacement windows REC-1999-000001
............-•-----•.....................................................••--............
Paid By: P...aid....i.......ull O.....0.--•---------
n Fn:
Larry Jubb Wed Jul 01,1998
•...............•-----•------•--•-----------------------.................................
Received By: Check No:
Linda Lapointe 2892
......--•....................••------------.........................-----............----
......................................
DEPARTMENT'S COPY Amount: $20.00
...........................
DEPARTMENT FILE COPY 90 DEERFIELD DR
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: Trackinp.No.: Fee:
01 Jul, 1998 BP-1999-0001 $20.00
GIS#: Map Block: Lot: Address: Zoning Use Group: Lot Size:
4895 29 171 001 90 DEERFIELD DR URA 18382.32
Contractor: License Type: Insurance:
Larry Jubb Inc Workers Compensation
Address: License No.: Insurance No.:
P 0 Box 429 10001 246Y5352UB
City: State: Zip Code: Phone:
GREENFIELD MA 01302
Project No: Category of Work: Const. Class: Cost Estimate:
JS--1999-0001 $2,285.00
Description of Work:
install replacement windows
GeoTMSO 1997 Des Lauriers&Associates.Inc. Cionwharo-