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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 1 q Additions
APPLICATION FOR PERMIT TO ALTER Repair
x
Garage
1. Location 2sy� ��� �� t�S 0(J Lot No.
2. Owner's name ` ,'e Address Pl. 00 U-j
3. Builder's name Address
/� Alf Mass.Construction Supervisor's License No. �� C ( Expiration Date �
4. Addition
5. Alteration
6. New Porch
7. Is existing building to be demolished? 1')
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines /
12. Type of roof 3� �� 4 i e =112- rC �� l r .
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
jowlledqe and belief.
Signature of responsible app icant
Remarks
I �2
Off`" TO
e1 SEP 2 '998 =saacflttsrtta
m DEPT Of b �i, � �,�?�PARTMENT OF BUILDING INSPECTIONS
NORTHAJ.PTO.W MR 0 1 izAain Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S OMPENSATION INSURANCE AFFIDAVIT
'7�L Z Z
(licenser/permi ttee)
with a principal place of business residence at:
t �� (,4,#l�'fCr✓t ��IP ('yr�f/ (phone#)
( ty/statrJzip)
do hereby certify, under the pains and penalties of penury, that:
( ) I am an employer providing the folloivirlg worker's compensation coverage for my
employees working on this job.
f ter- � ro.I all/
(insu=ct--Company) (Policy Number) (E ton Date)
( ) I am l5t1 proprietor ener 1 contractor or homeowner (circle one) and have hired
the contractofs-Ef—ed below who have the follovrng worker's compensation policies:
�!i Ii1C Oi OP.Ci CiO: a li:2a:'C ?rt ;�ii1C 1 ` :! (r?;71i21':OII D,tc)
` R_Il JILOt1lC,.
(Name of Contactor) jasli once Compauy/Policy Numt'�r) (Expiration Date)
(Name of Contractor) (Insurano: Communy/Pollcy Number) (Expiration Date)
(attach z idit coils eef if necczury to i^fccuunca pertaiaing to all c« a o s)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner perfoming all the work myself.
NOTE:please be aware that wi;ilo 6omeounm who cm-play pczzaaz to do mxinf • ,ccc:st ctioa or repair work on a dwelling of
not moon than tbtno Lufu in which the hoot-�-oc rain or oa t':groundr aPNrt-'a.A L4crrtn ate not gcncraily cowldacd to be
employes under the vvorker`i.00mpcasatica Act(GL152,--5 1(5)),,application by a homcowncr Cara Betas-cc permit tnay-id—t}x
legal ctatua of an employer undertho Woticcla Coaapocnition Act
I uadaV-end tbtt a copy of this rhtcmcnt rruy bo fom-ud« to tbo Dcp�of IndiLStriai Acc ids OfSao of In—for tbn
covtcagt vaificstioa and that failure to secure covtrngo under so, ion 25A of hIGL 152 can lead to tho'impasitioa of criminal pcnaltia
coasnt=z of a fuse of up to 51,500.00 and/or imprisoarncat of tip to ow year and civil pcn&1Ec3 in the form of a Slop W oric order and a
firm
0(5100.00.day against tna
Foc dcputu-e"uao Doty
' Permit Number
M20 Lot#h
Li nittcc
--- -
i
10. Do any signs exist on the property? YES NO V
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 —7== to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - front
side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open'Space:
(Lot area minus bldg
&paved parking)
# of -Parking spaces
t of Loading Docks
Fill:
(volume--& location)
13 . Certification: I hereby certify that the information coptained herein
is true and accurate to the best of my knowle ge.
DATE: APPLICANT's SIGNATURE
NOTE: Issuanoe of a zoning permit does not relieve a applioant's burden to oomply wltt�,�all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioabla permit granting authorities.
FILE if
a
(� V'
w 3 awo Fi 1 e NO.
DEPT of 8tili.i)`I IG ai<;r�CiiGtVS
N AbtPTON PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
I
1. Name of Applicant: LeLl,
Address:_ I�T uj e'-r °M
2. Owner of Property: A"
Address: U d �� S /� ° Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other('explain): �P-t-n 0 ���
4. Job Location: S- / v' Y(-1 mot"
Parcel Id: Zoning Map# �2!� Parcel# District(s):
(TO BE FILLED IN nBY TH B rUIILD NG DEPARTMENT)
5. Existing Use of Structure/Property --�es;
6. Description of Proposed Use,1 rk/P oject/Occupation: (Use additional sheets if n cessary):
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 KN0%N' % 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 cument#
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-.1.99.9-0.262
......• • .... ......
..... ......
Building, Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Roofing
.P�i. REC-1999-000636
'P'a'i'd...in...Fu,"I I...0...n":...........
Kevin Houlihan
................................................................................... Wed Sep 02,1998
.. . ...... ......
ceived By: .Check. . .No:...................
Linda Lapointe 2724
.........................................................................................
......................................
DEPARTMENT'S COPY Amount: $20.00
--------------- ......
DEPARTMENT FILE COPY 846 BURTS PIT 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:
02 Sep, 1998 BP-1999-0262 $20.00
GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size:
7268 36 189 001 846 BURTS PIT RD SR 31232.52
Contractor: License Type: Insurance:
Kevin Houlihan HIC
Address: License No.: Insurance No.:
218 Western Ave 110229
L41i State: Zip Code: Phone:
WESTFIELD MA 01085 (413) 562-3901
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0552 roofing $2,600.00
Description of Work:
STRIP & SHINGLE ROOF
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: