25A-048 (3) j ➢ a z
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. / 1 19 Additions
APPLICATION FOR PERMIT TO ALTER% Repair
Garage
1. Location? r n S � 4 S Lot No.
Cr os,� ST
2. Owner's name n ,^7'�� V�.I�v Address `1 �
V7 Sut',-) rp F Address (fez 7 S T Ct s r rAtO, 43. Builder's name YS/
Mass.Construction Supervisor's License No. O 3 r-I G G Li 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 Cr,-,,o roof and r t S-k pt w
13. Siding house rri m sole/-:t ct py Fa s1,►
14. Estimated cost:-` tt . 5 0, a
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
Signature of responsible app.icant
Remarks
�O4(11/V O w
Gift oaf Wart4amptan L
B
J1/u u' ' ixssxc4nsctta
� 1V
DEPARTMENT OF BUILDWG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORI{ER'S COMPENSAUON INSURANCE t=AVIT
t
L
(li cevscz"Jperm i tire)
with a principal place of busmesslresidence at:
(Etre City/ zip)
do hereby certify, under the pains and penalties of perjury, that:
( } I am an employer providing the folloNvmg worker's compensation coverage for my
employees working on this job:
(Lns'=ce Company) (Policy Number) (rxpiration 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:
(Nan),e of Contractor) JI1slltanC� Company/Policy Nuulbcr) (Expiration Date)
(Name of CooLn"Clor) Cl=ui-ncc Company/PoLicy Numb--r) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compaoy/Policy Number) (Expiration Date)
(mach additicml:fact if neeev_iry to h'dc infoaniti oa pertaining to&II eectracton)
(k<l arri a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE_please be avratc that whilo ploy pert to do mainttnaneS mm� 1Oa'cr riff work on a dvmUing of
not ma'o than tht-units in which t(x h=oow rcadc,or oa tho grnttnlls appttrtcnant tbacto ere oot geoerslly ooasidcred to be
employers under tho wodle oompcnsalicn Act(GL152,ss I(5)�,appli--ion by a homeowner for a 6ccWs a Permit may cvidcnoc the
legal sistas of an amployor undorthe Workce,compe ,aLioa Amt"
I undcrstaad thst a copy of this mt c meat may bo forwarded to tho Dcperrmmr of ID6 y 1 ai Amy O(fioo of i vm-oco for tbo
ooverxge vcrifieatioa and that failure to sceure coverago under soetioa 25A of MGL 152 caA ie+d to tbo'impostroa of crimiast prnalties
oomiziiIIg pf a•fine of up to S l�oo.00 anNcr i aprjsoanicul of up to.o=year and civil P=316c3 is the form of a stop Work Ordtr.and a
fittA of S 100_ ><day Lp" trio
For dcpxrtma bit u"colt
Pcrmt
4 Ntlznbes ,
Ma
S of Liccnscx Pcimi.ttbc
.mot
t ! ' FILE # 963671.
.IN I 1 59%
PL CANT/CONTACT PERSON:
ADRESS/PHONE:
PROPERTY LOCATION:
MAP PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION_CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FH.T.FD OUT
Fee PAid
Arreccnry !;triyehire
i OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION'
Approved as presented/based 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
Septic Approval-Bd of Health Well Water Potability-Rd Health
eYmi �c} 9otLWW olnmiss'
PD
eoc
16111/,/
Signature of Building Inspector Date
NOTE:lanuanoe of a zoning permit does not relieve an appiloant's burden to oomply with all
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission, Department of Publio Works and other applionble permit granting authoritlas.
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 colu= 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
&paved parking;
# of -Parking Spaces
ht of Loading Docks
Fill:
-(volume--& location)
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowled
DATE: - it APPLICANT's SIGNATURE
NOTE: Issuano a zoning permit does not relieve an applicant's burden to oomply with all
zoning requiramants and obtain all required permits from the Board of Health, Conservtation
Commission, Department of Publio works and other applicable permit granting authorities.
FILE #
`f ► ►s98
File No.
w ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: W-e-S Tr e✓1 �S`s �t��<r nt /qvv rCn n
Address: 6 -5 Lloa y r r o k,Telephone:_ -7
2. Owner of Property: , /fie &,I .t-
Address: 4/ C0 t j� 5'r ,—I——f 7 h Telephone: ��"Z-/ � 3 O D
3. Status of Applicant: Owner y Contract Purchaser Lessee
Other(explain):
4. Job Location: ''/ C -o 5 Y 577-
V-6 Parcel Id: Zoning Map# <9?fi Parcel# District(s):
(TO BE BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property k4021
6. Description of Proposed UseM/ork/Project/Occupation: (Use additional sheets if necessary):
g "3 of /Jr Sa 1�/�,°� t�rr f� ct /ysr7.'k7uk,,-
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 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)
Reference No: BP-1998-0048
Department: ...................................
Building, Electrical & Mechanical Permits
........•................................................................................
Fee Type: Receipt No:
Roofing REC-1998-000052
.........................................................................................
......................................
Paid By: Paid in Full On:
Western Mass Siding & Roofing Thu Jun 11,1998
.........................................................................................
......................................
Received By: Check No:
Linda Lapointe 2122
.........................................................................................
......................................
DEPARTMENT'S COPY Amount: $20.00
...........................
DEPARTMENT FILE COPY 4 CROSBY ST
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: 1�9,- Inspector: Tracking No.: Fee:
11 Jun, 1998 BP-1998-0048 963671 $20.00
GIS #: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
4266 25A 048 001 4 CROSBY ST URB 15158.88
Contractor: License Type: Insurance:
Western Mass Siding&Roofing
Address: License No.: Insurance No.:
63 East Street
City: State: Zip Code: Phone:
EASTHAMPTON MA 01027 (413) 586-5227
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1998-0049 $11,250.00
Description of Work:
strip & shingle roof
GeoTMS*1997 Des Landers L Associates.Inc. Cianoh■ra•