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Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 7 5�77�5 Alterations
NORTHAMPTON, MASS. Additions
APPLICATION F -PERMIT TO ALTER Repair
Garage
1. Location Lot No.
2. Owners name Address
3. Builder's name Address
Mass.Construction Supervisor's License No. c'�k/g-5� 9f Expiration e
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
14. Estimated cost:- S�
The undersigned certifi the abov to m nts are true to the best of his, her
knowledge and be
Signq,lure of responsible apPicanl
Remarks
0 4�1sAMpTO
It
moo� � �aSSACl�ttafll5
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�v �PArRTMENT OF BUILDING INSPECTIONS
EPi OF Bli SG iNSPEGT101a.
act,v;duv <Main Street e Municipal Building 'o
Northampton, Mass. 01060 'J�y
R'S CO FN ATION INSURANCE AFFIDAVIT
1-,
picensec/permittee)
with a principal place of busine resid ace at-
(phoney#)
(stmeticity/stair/ p)
do hereby certify, under the pains and penalties of peg ry, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Daze)
I'ufi a sole proprietor, genkral contractor or homeowner(circle one) and have hired
the contractorsTst elow who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (insurance Company/Policy Number) (Expimdoa Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additiooal shoct ifnocessary to inc}udz info tuition pertni�to all cow radon)
am a sole proprietor and..haYe.na one.working for
( ) Y am a homeowner performing all the work myself.
NOTE:please be aware that whilo homcowncrs who ernploy persons to do mahAcaatice,comuuctioa or repair work on a dwelling of
not more than throo units is which the bomeownct resides or on the grouads appurtenant tba-do are not wally ooendered to be
employers under the worker's oonVco:u4oa Act(GL152 fa 1(5)),application by a homeowner for a liocase or permed may cvidcnoe the
legal slaw ofan employer under the Worlceez C.ompamatioa Act
I understand that a copy of thin statemcat may be forwarded to tbo Departnacot of In dustrial Accidaa&O$ioe of i"=' >moe for the
coverage verification and that failure to&==coverage under sccuoa 25A of MGL 152 can lead to tbo inV�on of criminal pcaalties
comistbig or,fine of up to S1,500.00 and/or im{uiso�of up to one year and civil penal6cs is the form of a,Stop Work order and a
firm of S 100.00 a day against tae.
Sign _( dAy of For dq=tm=t1l use oaty
Permit Number
Map# I.ot#
Si of Li�see!Perrnid=
r ,
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 COMPLE'T'ED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This colimm to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
' &paved park.ingi
# .Pf Parking Spaces
# of Loading Docks
Fill:
A vol-time-& location)
13 . Certification: I hereby certify that the infor on n a ned herein
G is true and accurate to the best of my know dg .
DATE: - C� APPLICANT's SIGNATURE
?" NOTE: 1 uanoa ot a zonin
g permit does not relieve an IioanYs b rden o comply witk"ell
zoning uiraments and obtain all required permits from the Board of Health, Conservation
Comma on, Department of Publio Works and other applioable permit granting authorities.
FILE #
�.Lc 1 �
MAR 2 82000
File No. "N / I
r ZONING PERMIT APPLICATION (§10 . 2
P E O74;_ ALL INFORMATION
1. Name of Applicant: I
Address: t T lephone:
Z - / ���K2 2. Owner of Property:
Address: Telephone:
3. Status of Applicant: Own ontract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# jD17 Parcel# District(s): iliyl
(TO BE FILLE IN B THE BUILDIN EPARTMENT)
5. Existing Use of Structure/Property �-eJ
6. Description of Proposed Use ork/Project/Occupation: (Use additional sheets if necessary):
7. Attached Plans: Sketch Plan ite Plan Engineered/Su eyed 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)
16 MARSHALL ST BP-2000-0814
GIs#: COMMONWEALTH OF MASSACHUSETTS
1U:Block:25A-058 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: roofin g BUILDING PERMIT
Permit# BP-2000-0814
Project# JS-2000-1535
Est.Cost: $4385.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: ROBERT D THIBODO 118441
Lot Size(ss . ft.): 100 1 8.80 Owner: MOOS STEPHEN E&SHEILA N
Zoning: URB Applicant: ROBERT D THIBODO
AT. 16 MARSHALL ST
Applicant Address: Phone: Insurance:
P O BOX 201 (413) 527-8966
NORTHAM PTO NMA01061 ISSUED ON:3128100 0:00:00
TO PERFORM THE FOLLOWING WORK.STRIP & SHINGLE ROOF
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
�aInspector 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:
Owk Building 3/28/00 0:00:00 7086 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo