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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.< Alterations
NORTHAMPTON, MASS. / "^` � 19 er Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location �� /� � Ir Lot No.
2. Owners name e!Cs'rlu*l s�'/�' �^ 1/ Address
3. Builder's name ��r Tom/ �' Address '
Mass.Construction Supervisor's License No. //z Expiration Date_f/— �R
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 s .�
i
13. Siding house
14. Estimated cosy,-Aede�
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief. '
Signature ojresponsible appicant
Remarks
o O
MAY 2 2 '1998 Crft- a nt r air
L
9 B �ressxcbtrsctta
DEPARTMENT OF BUILDWG INSPECTIONS '
212 Main Street ' Municipal Building 'to
Northampton, Mass. 01060
WORICER'S COMPENSAUON INSURANCE AFFIDAVIT
� (licenser/permitter}
with a principal place of busWess/residence at:
(phone#)
_' (str�t/city/statrlap)
do hereby certify, under the pains and penalties of persury, that:
( ) I am an employer providing the follollving worker's compensation coverage for my
employees worming on this job:
(insurance Company) (Policy Number) (Expiration Date)
O 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) (insuEanc_– Company/Policy Number) (Expiration Date)
(Name of Contactor) (Insv=cc Compauy/Poky Number) (Expiration Date)
(Name of Contractor) (1nsurance Compaay/Pobcy Numbu) (Expiration Date)
(Name of Contractor) (insurance Company/Policy Number) (Expiration Date)
(ettach additioatl-hod if noocsury to iDC}udc infix 60'n pertaining to all ooatrn rs)
I am a sole proprietor and have no one working for me.
I am a home owner performing all the work myself.
NOTE-please be aware that v?ailo hommwncrs wbo cmptoy periam to do m �w"'nucxioo or repair work on x dwelling of
not mono than throe unite is which the bomoowocr r=dce or on the grounds appurtcnani thetdo arc not gco,,r y coasidacd to be
employaa under the workce comp==tica Ate(GL152,n 1(5)),appLicabon by a homeowner for a U-31-cc p0m3a=Y cvdtooc the
legs!rtntuJ of an employer under the Wocicce, ,.iioa Act.
I unAcrdAnd that i copy of thu mfr d mxy be focwwded to tbo Dcpar�of to u liJ A1660O&Off'Oe orlawt-DOe for 260
covaxgc vaificatioo and that failtm w t:eatre covcragu under section 2SA.of MOL 152 can.lrsd W the'imposdtoo aCctimiasl pcnaltia
conustiug of x•tint-of up to 11,500.00 and/or of tip to-one year and civil pcaxttics in the form of a Stop Woiic Qcder.and a ,
5rn o(5100,00 a dry agninA ma
For dCP=taxnbj uio coly
.permit Number
�t P.
Y:
Si
&.ahrre of LiocnsceJPccmixt;re
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 MAST BE COMPLE'T'ED, or PERMIT CAN BE DENIED DQE TO
LACK OF INFORMATION.
This column to be filled in
by the Building D part u t
I Required
Existing Proposed By Zoning
I Lot size
Frontage
Setbacks - frnnt
- 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
�r is true and accurate to the best of my knowledge.
DATE: 'r= '_ APPLICANT's Sl'GNAT= r-
NOTE: Issuance of a "`� �
g permit does not relieve an appTioan s bur n to oompty with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
)Commission, Department of Publio works and other applioable permit granting authorities.
FILE #
I : 2 '1998 '
MAY 2
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: z' 11 D'! �� �s_���'L/
Telephone: b `� '�-�L4
2. Owner of Property: �
_A,'(- � �"� i�� ,
Address:-, ;z1 Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map#_ Parcel# District(s): ZYAYL-
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5 Existing Use of Structure/Property
6. Description of Proposed Us Mlork/Pro. ct/Occupation: (Use additional sheets if neon ary):
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/Variance/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)
FILE
MAY 2 21998 j
APPLICANT CO TACT PERSON-
DEPT OF W0PU$S '0
PROPERTY LOCATION: a
MAP PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERNIIT APPLICATION.CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM MIED ()1T1
Fee pnid
c/
r
THE LOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION-
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-Bd Health
Permit from Conservation Commission / ¢�
Signature of Building Inspector Date
NOTE:Issuanoe 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 applioable permit granting authoritle-
Reference No: BP-1998-0020
Department: ...................................
Building, Electrical & Mechanical Permits
......................................................................................
Fee Type: Receipt No:
Roofing REC-1998-000023
...... ........------....--------------......
Paid By. Paid in Full On:
Scott Paquette Tue May 26,1998
......................................................................................... ......................................
Received By: Check No:
Linda Lapointe 173
......................................................................................... ......................................
DEPARTMENT'S COPY Amount: $20.00
---------------------------
DEPARTMENT FILE COPY 39 DAY AVE
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: (0f� Inspector: Tracking No.: Fee:
26 May, 1998 BP-1998-002 t Stanley Szewczyk 963571 $20.00
GIS #: Man Block: Lot: Address: Zoning: Use Group: Lot Size:
4346 25A 132 001 39 DAY AVE URB 23565.96
Contractor: License Type: Insurance:
Scott Paquette
Address: License No.: Insurance No.:
58 Line Street
City: State: Zip Code: Phone:
EASTHAMPTON MA (413) 529-2260
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1998-0021
Description of Work:
Strip existing roofing and install], new
GeoTMS®1997 Des Lauriers&Associates,Inc. Signature: