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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.sF - Jd�r�- Alterations c_/
NORTHAMPTON, MASS. 6 -1921-,
19 21+ Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location Lot No.
2. Owner's name,/Ll tom} tom^,' / Address 2-Z
3. Builder's name � 1 y� �J +�'���� Address
Mass.Construction Supervisor's License No. OD 2�?O f Expiration Date YgAr
4. Addition Z ,
5. Alteration "00 4-1 T I'd G t I/�n.--
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 i/Cj J".' ')-)'I C>
11. Distance to lot lines 1�
12. Type of roof '1J✓�
13. Siding house n2-1-4 -'
14. Estimated cost:061j,).eq L,0
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible app icanl
1
Remarks �Z— U e x )1 ' j O � � �cJ' CJ �✓}j f'
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m DEPARTMENT OF BUILDrXG INSPECTIONS
" .y 212 Main Street Municipal Building y
Northampton, v
Mass. 01060
WORI{TR'S COMPENSATION INSURA-NCE AFFIDAVIT
v✓ith a principal place of buSM' cSs1resldence at:
(pbonett)
(strr^I/ci ty/stat f-12i p)
do hereby certify, under the pains and penalties of perjury, chat:
( ) I am an employer providing the following worker's compensation coverage for my
employees woriing on this job-
(Insurance Company) (Policy Number) (Expiration 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) (Lns=icc Compauy/PoLicy Ntunbcr) (1�u-atiou Date)
(Name of Contactor) (Insurance Company/Po6cy Ntmmr) (Expiration Date)
(Name of Contractor) 011urancz Company/Policy Numb-ir) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(att�.cll a.dditicml_sect dnoociuy to include i formiLioo patnining Wall
I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:plcnac be awuc[hd wbilo hoc cx wy aj vbo coplay perraas W do %**fr.,.,,n coc: v C'Qn or repair work on a(INWI ing or
not morn than throo units is Wb3ch t1x ooc dcrcd to be
bomoowacr rtxido or oa rho psmtod�appurica+ni tbctctn aR oo(�nlly
cmplayc"under iha w-kcel oompca",iiea Act(GL152-,a t(5)),applic3.600 by a homcowncr for a liana cc P-r may evi'3."the
legal rtnhii of an omployoc under thn Wocicotc c,,, aaiioa Act
I uxKlavtand dvA a oopy of this m cmcat may bo forwarded to Lb.DcpertmaH of 1.65.ri a%/wadpp&OfEOO of Ia ur for the
oovcrxge vaificatio0 and that fultmc to comic covcrago under suction 23A of M43L 152 czA lrxd to tbd impoirtion Of aimi'4 pmaltin
oom stung pf A. a c bf uP 10 51;300.00 aadtoc i aprssoamc>st of tip to.o0c year end aVa Pcolltia is the form Of a Stop Work Oedtr.and a ,
Jiro of S 100:00'x city t iait uic
Poe d trio oaly
Y; of Liocnsoc7Pcriiiiticc _
10. Do any signs exist on the property? YES NO
IF YES, describe size,type and location: " s AL
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 —I— to be filled is
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height & / l
Bldg Square footage Ecp /yy
Cc 1 i Sc) '5' o C',"i'3'
%Open Space:
(Lot area minus bldg
&paved parking)
f -Parking Spaces
f rof 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.
_1
DATE: 6 `� APPLICANT's SIGNATURE
NOTE: Issuanoe of as zoning permit does not relieve a ppiloanVe burden to comply with,all
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 #
Fi 1 e No. - ='
�A---�-- Q11�ING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 5Ayp r'j '/ W O C ij
Add ress:-5-G M✓9hik-�i7t s 1-; UV6J }�� J_Telephone:
2. Owner of Property: 4C
Address:'i 3 F/� �.�>�c.1r D"��/L'G'{iTelephone: 010610
3. Status of Applicant: Owner _Izcontract Purchaser Lessee
Other(explain): ✓� p
4. Job Location: IZ� fdliL �',•c��i C� /(/�/ : �dl�f��i�t/�� IK19'j
Parcel Id: Zoning Map# Parcel# l �. District(s): 3/
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property %
6. Description of Proposed Use/Work/Project/Occu ation: (Use additional sheets if necessary):
T
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 PermitAlariance/Finding ever been issued for/on the site?
NO DON'T KNOVV L, ee 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? NOyDON'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)
FILE if 963663
JIN I i
I C•/
APPLICANT/CONTACT PERSON: —C)/Cl
ADDRESS/PHONE:
Ali-I-
PROPERTY LOCATION:
MAP �.36 PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM OUT
Building Permit Filled nut
Tnte
A crPCsn�trii�tiire
T FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATIOM
Approved as presentedfbased on information presented
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received &Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
ell Water Potability-Bd Health
!Permit from Conservation mmission
Signature of Buil g r Dale
r
NOTE:Issuance of a zoning permit does not relieve an applicant's burden to comply with all
_ zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applicable permit granting authorities.
Department: Reference No: BP-1998-0055
...................................
Building, Electrical & Mechanical Permits
Fee Type: Receipt No:
Non structural interior renovations REC-1998-000059
.............................................................•---........ ...... ...............................
Paid By: Paid in Full On:
James Dawson Mon Jun 15,1998
......................................................... .....................
Received By Check No:
Linda Lapointe 1987
..---•--.......--•...................................................................•-•- ......................................
DEPARTMENT'S COPY Amount: $40.00
...........................
DEPARTMENT FILE COPY 723 FLORENCE RD
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: o Inspector: Trackin No.: Fee:
15 Jun, 1998 BP-1998-005)6' q 963663 $40.00
GIS#: Man Block: Lot: Address: Zoning Use Group: Lot Size:
7252 36 172 001 723 FLORENCE RD SR 14461.92
Contractor: License Type: Insurance:
James Dawson CSL
Address: License No.: Insurance No.:
56 Market Street 002701
City State: Zip Code: Phone:
NORTHAMPTON MA 01060
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1998-0056 $5,000.00
Description of Work:
Install bath in basement, and renovate upstairs bath
GeoTMS 8 1997 Des Lauriers&Associates,Inc. Signature: