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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location :2 3 9 1' ������C Lot No.
2. Owner's name 136 r �u r c{ (L 1 . -ir4c:r Address 3 9 /^f c,r `, c-e t- c,/
3. Builder's name .6 eky—c :J-'t -r:X Address
Mass.Construction Supervisor's License No. P-7, Expiration Date /9 9
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 -, v
14. Estimated cost:- 1i 1-a-3 .
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
Signature of responsible app icant
Remarks
04�liA�lp�O
9 8 (!_�ifLy of Neirt4all yton
� A�� 3 �� �tcsaarE[nsrtls
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street e Municipal Building
Northampton, Mass. 01060
WORICER'S COiYIPENSATION INSURANCE ATTIEDAVU
;�--
c�ip
with a principal place of business/residence- at:
j ulC';t 0
a ce, fft (phone#)
(str-etii/ci ty/staf clap)
do hereby certify, under the pains and penalties of penury, that:
( ) I am an employer providing the follotiving worker's compensation coverage for my
employees working 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) (Ins-urancc, CornoarrylPoky Nunikr) (Expiration Date)
(Name of Contractor) on-suraricc C0mpa11y/Poiic,f Nuznt-Cr} (Expiration Date)
(Name of Contractor) (Insuraac:e Compauy/Poticy NumJxr) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additioail 1hC t ifntecuaryto mch inform tioa *im to all ccatracton)
O I am a sole proprietor and have no one working for me.
( ) > am a home owner performing all the work myself.
NOTE:plcaac be aw=that v bilo homcowvaa wix3 cmploy persom to do *� coastruaion or rcpair work on n dwelling of
not more than three units is winch the bomoowncr reside or on the gtoutxh apputtcnsa th=w a,pct gently considered to be
employ=undcs tbo wotka's oanp=z4oa Act(GL152-m 1(5)),applicz6on by a homcown s for a tica=a permit may evidence tho
lcgtl rtahta of an employer under tho Wocixet Compmution Ac
I undcntand that a copy of this rtucmcot may be forvmrded to the Dcpertmco t of Iodu31ria1 Acct&mta'Offioe of Inzvcwoo for the
--ge vaificatioo and that failure to aaztrn covcrago under soctioa 25A of MGL 152 can Iced to the impos Of of aiminal pcpaltica
ooasut mg of a fine of up to S 1,300.00 an&or impri5o u of tip to one year and Civil pcnaada in the form of a Stop W ork Ordcr apd a
fi,m of 5100.00&'&Y against ax.
For dgmtmeral use only
Permit Number
Meg# Lot,#
Sigaatme of Li ermittce
10. Do any signs ebst 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 MAST BE COMPLE'T'ED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This colt to be filled in
by the Building 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
&Pax,ed Parking)
# of Parking Spaces
ht 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: f� 74f APPLICANT'S SIGNATURE
NOTE: Issunnoe of a zoning permit does not relieve an ap ioa b , o
rden to omph► wlt4 4111
zoning requirements and obtain all required permits fro the oard of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
AUG 3 ,998
File NA-Vidy
...F. ZONING PERMIT APPLICATION (§10 . 2
PLEASE TYPE OR PRINT ALL/j INFORMATION
1. Name of Applicant: -A_ <f Y, -�e Y' r % 7�
/ b
Address: Telephone: �' 9 '� – q0 7
2. Owner of Property: 8_,:0r b G r ck G/,'Aec"r J
Address: :2 3 P ore i\ CC /QC/ Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): ,G//��=��1
4. Job Location: :2 3 �"/Q t-eri r-Y paj ,
Parcel Id: Zoning Map# Parcel# U District(s)W16—
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property e�r
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/Vadance/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-.1.99.9-.013.7......
Building, Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
....Vinyl siding..................................................................................... RE( 1999-000249
Paid By: Pa.id.'i`n"F"u'1-10'n:.....
Jerry Hebert
................. ....................................................................... Mon Aug 03 1998
.. . ...... ......
Received By: .Check.No:...................
Linda Lapointe
11,05
......................................
DEPARTMENT'S COPY Amount: $20.00
............ ..............
W"'PARTMENTFILE COPY 739 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: Inspector: Tracking No.: Fee:
03 Aug, 1998 BP-1999-0137 $20.00
GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size:
7250 36 170 001 739 FLORENCE RD URB 15768.72
Contractor: License Type: Insurance:
Jerry Hebert HIC
Address: License No.: Insurance No.:
28 Glendale St 119362
L!!E State: Zip Code: Phone:
CHICOPEE MA 01020 (413) 594-4079
Pro iect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0200 vinyl siding $11,223.00
Description of Work:
INSTALL VINYL SIDING
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: