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Zoning
Miscellaneous Additions,Repairs,Alterations,etc.
/� Tel.No. J'�Y7-9St37 Alterations
NORTHAMPTON, MASS. (,rA - AR 191 Additions
~• Repair
' APPLICATION FOR PERMIT TO ALTER
Garage
1. Location Lot No.
2. Owner's name Address
3. Builder's name Address Mrj
Mass.Construction Supervisor's License No. o39-Yd4 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 L"Fn '%A:. -
13. Siding house Uv
14. Estimated cost:- f
v�00o •eo
The undersigned certifies that the above statements are we to the best of his
knowledge and belief.
Signaturt of responsible app�icant
Remarks
O�'i11A1NP�0 a --
Grit� of t 4
� � Massachusetts 'a
LldiR�PT PR 2 2 ►9� ,
DEPARTMENT OF BUILDING INS
INSPECTOR 212 Main Street • Mmticipal B stt. tp r
t ��, y.•�
Northampton,MA 01060
Applicant Information
Names �"� ---------------------
Location/�� ----- ------------
City., -----------------
El I am a homeowner performing all work myself
Ci- I am a sole proprietor and have no one working in any capacity
❑ I am an employer providing workers' compensation for my employees working on this job.
Company Name---------------------------
Address------------------------------
C it Y------------------- Phone#----------
Insurance Co._------------ ---
Company Name
Address
City Phone#
Insurance Co. Policy#
Failure to secure coverage as required under Section 25 A of tylGL 152 can lead to the imposition of criminal
penalties of a fine up to$1500.00andlor one years'imprisonment as well as civil penalties in the form of a STOP
WORK ORDER and a fine of$100.00 a day againstme. I understand that a copy of this statement may be
forwarded to the Office of Investigations of the DIAfor coverage verification.
I do hereby certify under the pairs and penalties of perjury that the information provided above is true and correct.
Signature � ! Bel �� Date_�A,
Print Name M.�te a Phone# �99�37
Official Use Only Do not write in this area to be completed by city or t:wn ]
City or Town PermitlLicense#
d Check if immediate response is required Contac t Person .Phone
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 col-mm to be filled in
by the Building Department
Require
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 carkij-ng)
# 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.
DATE: Iag' APPLICANT's Sl-GNATURE rn• �
NOTE: I of a zoning permit does not relieve an applioant's burden to oomply with gall
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applicable permit granting authorities.
FILE #
p T .�N
File No. 9 7k
AM 2 2 F999
-ZONING PERMIT APPLICATION 010 . 2 J
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: l77'WjA' ttef-7—� �a4gkL hAFI Telephone.
1 Owner of Property:
Address: Telephone:
3. Status of Applicant: ✓ Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# -! Parcel# 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):
-- Maw fdau s. -n�11— "1 FA Aft
i
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.
S. Has a Special PermitNadance/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)
39 GILRAIN TERR BP-1999-0878
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29-063 CITY OF NORTHAMPTON
Lot:-001
Permit: Build ina
Category:roofing BUILDING PERMIT
Permit# BP-1999-0878
Proiect# JS-1999-1524
Est.Cost:$5000.00
Fee:$20.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: W M Brown 038426
Lot Size(sa. ft.): 17685.36 Owner: HARDY GLORIA
Zoning:URA Applicant• W M Brown
AT: 39 GILRAIN TERR
Applicant Address: Phone: Insurance:
177 West St (413) 247-9937
WEST HATFIELD 01088 ISSUED ON.4/22/i999 o:oo:oo
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE 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 Occupancy Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 4/22/1999 0:00:00 $20.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo