25C-257 (5) a c
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS.
19,z//— Additions
a APPLICATION FOR ERMIT TO ALTER Repair
Garage
1. Location_—�i ,, r� Lot No.
2. Owner's name Address ,/r-3. Builder's name Address 615—
Mass.Construction Supervisor's License No. 64 3_ FQ& Expiration Date �/rSi�ioa�i
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
14. Estimated c st-
The undersigned certifies that t true he above statements are to the best of his, her
�
knowledge and belief.
649--,--re -f--won"bil a i
Remarks
Wer
04 -
2
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°DEPARTMENT OF BUILDWG INSPECTIONS
212 Main Street ' Municipal Building 'a
Northampton, Mass. 01060
WORICER'S COMPENSATION INSURANCE AFFIDAVIT
(licenser/ rmittee)
with a principal place of business/residence at:
(stre_-t/city/sWd7iP)
do hereby certify, under the pains and penalties of penury, that:
W- am an employer providing the following worker's compensation coverage for my
employees working on this job:
& cI` e/zz Z � ���� O Z- l0 zoad
(Insurance Company) (Policy Number) (Exptrati n Dale)
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:
(Flame of Contractor) (Insul-anc_- Comoany/Policy Number) (Expiration Date)
(Name of Contr actor) (Insurance Company/Polio;Number) (Expiration Date)
(Name of Contractor) Jasu.raact Comparry/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance ComDmy/Poky Number) (Expiration Date)
(attach additional shoes if n6ocn ry to in,}- mfor mitt on pertaining to all 00"t d ra)
( ) 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 aw2rn that while homcowvm wbo employ patens to do maintcawce,construction or repair worst on a dwelling of
not mote than throe units is which the homoowncr raids or on the groua ds appurtenant thatto art no(generally coaridcrcd to be
employers under tho worker`s compcm4on Act(GL152,ss1(5)} application by a homeowner for a licuuc cc Permit maY"id—the
legrl o utua of an employer under the Worker's Compeow-lion Act_
I understand that a copy of this ctatcmcnt may be forwarded to tho Dcpartmcat of Indarstri d Ac6de0&Of5oo of 1nA9vn0o for the
oovcr g verification and that failure to satire covctugo under section 25A of MoL 152 can It'd to rho impasi -of criminal pemltia
ooni sing of a fine of up to S 1,500.00 andlor imprisomncat of up to one year and civil pen trier is the form of a Stop Work Order and a
fim of 5100.00 t day tpitut ma
For d p=ta=W tuo only
Permit Number
Afiap# Lot#
gnature of L" c tttx
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 ccl== to be filled in
by the Building ne-partment
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 par!:ing N
# of4Parking 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.
DME: APPLICANT's SIGNATURE
NOTE: lss an e tif a zoning permit does not relieve an pplioant' rden mply with ,ill
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission, Department of Publio Works and other applionble permit granting authorities.
FILE #
J �
61999
File No.
..,.,.
--ZONING PERMIT APPLICATION §10 . 2
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: a z '2
Address: x.25- & ¢,17G Telephone:
2. Owner of Property: A&tta lo 7t
Address: /,3 �i,-4 5r- Telephone:
3. Status of Applicant: Owner 6-to_ntract Purchaser Lessee
Other(explain):
4. Job Location: 4_5
Parcel Id: Zoning Map# �J Parcel# District(s):
(TO BE FILLED IN BY THE BUILDINb DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupabon: (Use additional sheets if necessary):
o r S c°t"I�mt
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/VarianceiFinding ever been issued for/on the site?
NO DON'T KNOIhf 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)
a
15 FAIR ST BP-1999-1006
GIs#: COMMONWEALTH OF MASSACHUSETTS
Man:Block:25C-257 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:roofing BUILDING PERMIT
Permit# BP-1999-1006
Project# JS-1999-1705
Est.Cost: $3555.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Groin Alan Shumway 013908
Lot Size(sq.ft): 8450.64 Owner: COTE NORMAN C&ANNE T
Zoning.URA Applicant: Alan Shumway
AT. 15 FAIR ST
Applicant Address: Phone: Insurance:
625 Pleasant Street Workers Compensation
AMHERST 01002 ISSUED ON.5126l1999 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP, PLY & SHINGLE REAR SECTION OF ROOF
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:
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 Occupy Si nature•
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 5/26/1999 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo