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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
ti NORTHAMPTON, MASS. ��'-t ;0 199 6 q Additions
APPLICATION FOR PERMIT TO ALTER Repair
I Garage
1.1. Location �3-F i R'Cobk- Sln� ���c%`� ��'���G� Lot No.
2. Owner's name 'D14.115 9,4 Address
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3. Builder's name 73c)� 4 :5 v C - - --L G- Address �'9l
Mass.Construction Supervisor's License No. D � `t5�� Expiration Date 0,1 a 7 �4,0a 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
12. Type of roof
13. Siding house 5i/Jir0i
14. Estimated cost:- lJ✓�
The undersigned certifies that the above statements are true to the best of his, he
knowledge and belief...
> Signature of responsible app,icanl
Remarks
�'Cl1M1P�.
B '�€ ^�3 �ASf R[t�7lDtttD
s F
aUJ, UN DZri8t 9MENT, P BUILDING INSPECTIONS
INSPECTOR 212 Main Str t • Municipal Building
DEf C ur �Lt� a� ;i'"' Pton, MA 01060
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Applicant Information
Name
Location _---_------ _-------_---
City--- ---- --------------------
1 am a homeowner performing all work myself
❑ 1 am a sole proprietor and have no one working in any capacity
I am an employer providing workers'compensation for my employees working on thisjob.
Company Name _L ----- --
Address --
City /9 .3 M ----- Phone# 7--
Insurance Co.-�,S-t"c�_� LAS -r��S Policy# /UUodg�' —_
Company Name
Address
City Phone#
Insurance Co. Policy#
Failure to secure coverage as required under Section 25 A of lYIGL 152 can lead to the imposition of criminal
penalties of a fine up to$1500.00andfor one years'imprisonment as well as civil penalties in the form of a STOP
WORK ORDER and a fine of$100.00 a day against me. I understand that a copy ofthis statement may be
forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify under the pairs and penalties of perjury that the information provided above is true and correct.
Signature 1_J__ � 1 Date
Print Name lv 11����J Phone x ,5 7
Official Use Only Do nol write in this area to be completed by city or town official
City or Town PermiVLicense OF ❑ DaMinc Dept
❑LiewiM Bond
Check if immediate response is required ❑St> Dept.
Contact Person Phone 1-
Q Health Dept.
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2 1999 y/
File No L'
PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 64 ''J L oeA0
Address: 71;/ 4y1f �� 1(112,44 elephone: J"g6' Z/47
2. Owner of Property: DIAAJ'�? S�,40zf
Address: fec X , 649—PcZ, Telephone:
3. Status of Applicant: Owner _Contract Purchaser Lessee
Other(explain):
4. Job Location: _
Parcel Id: Zoning Map# Parcel#---��` '--Q District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
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 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)
BP-1999-1041
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map.Block: -
?' CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:replacement windows/siding BUILDING PERMIT
Permit# BP-1999-1041
Project# JS-1999-1757
Est. Cost: $6685.00
Fee: $20.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor License:
Use Group: B & R Siding 100465
Lot Size(sq.ft.): 18556.56 Owner: SEAVER DIANE L
Zonin Applicant: B & R Siding
AT: 383 BROOKSIDE CIR
Applicant Address: Phone: Insurance:
781 Bridge Rd. (413) 586-4167 Workers Compensation {
NORTHAMPTON 01062 ISSUED ON.614/1999 o:oo:oo
TO PERFORM THE FOLLOWING WORK.-INSTALL VINYL SIDING & REPLACEMENT WINDOWS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Final: Final:
Rough Frame:
Gas Fire Department Fireplace/Chimney:
Y
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 6/4/1999 0:00:00 $20.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo