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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. S Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location ,;!�_ 41 Lot No.
2. Owner's name M� o Address Goa re Jk
3. Builder's name
0 )-- Address
Mass.Construction Supervisor's License No. of 2 $ 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 %4-),V "
13. Siding house
14. Estimated cost:- 93
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
S ature of responsible app,icant
Remarks
"Wmxf pl
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m DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street e Municipal Building 'a
Northampton, Mass. 01060 '
WORTCER'S CONITENSATION INSURANCE AF t AVTT
�o
(Il c�n sec/permi tree)
tivith a principal place of business/residence at:
Qj
�"' n (phone#)
(s�-etii/ci ty/statrJnp)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following 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) (Insurance Comgany/Poticy Number) (Ex mnri Date)
(Name of Contractor) (Insurance Company/Pokv Number) (Expiation Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(atladt additional s:xci tf nccr to ioc side infoctu .pctnining to all coatradon)
am a sole proprietor and have no one working for me.
( ) X am a home owner performing all the work myself.
NOTE:please be awatn that tvbilo hcmeoKacrs wtr3 uMploy persons to do M jnj ^n ooastucCion or repair work on s dv t ag of
not morn than thrco units is wffich the bomoowncr r ids or oo Lb.--grounds appurten•t lh=to arc oot gcn=11y masidcred to be
eazploYcrs undo•the worker's oompcmauon Act(GLI52-T:%1(5)),application by a homcowncr for a licm3c or permit may evidence the
legal d.ahra of an employee under the Woi x Compoozation Act
I undcrsiand du&a copy of this dstcmc d may bo fcxaYUded to tho Dopwtmco2 of Industrial Accjacn Offioe of lnwranca for tlm
coverage VMficstioo and that ailure to&==cov raga u ndcr sxtion 25 A of MGL 152 can lead to tba imposition of ctimiasl penalises
oomuiYn9 of a f ne of up to S 1,500.00 andloc of tip to om year and civil pwaltia in the form of a Stop Work.Orddr and a
film of 3100.00 a day tgniast ma
d
For dcp Ujo Oat/
Permit Number
Magi Lot#'
igaaWm of Li ermittee
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 ccluma 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
&pei,ed parkingi
# of -Parking Spaces
f 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: APPLICANT's SIGNATURE Nt_i
NOTE: Issue oe o a zoning permit does not relieve an applioont's Kurden to oomply ",ail
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appliomble permit granting authorities.
FILE #
t
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPEE� OR PRINT ALL INFORMATION
1. Name of Applicant:
Address:
LZIS� Telephone: S`—f/ " 2
2. Owner of Property: 61.2 qc &v f±('
Address: (, �'r NU f Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
—Other(explain): r
4. Job Location: Zhle
Parcel Id: Zoning Map# Parcel# _ District(s):
(TO BE FILLED IN BY THE UIL ING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
— -��+Zk BPD
J�nC car N S C P S
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 KNO%' 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-1999-0167
Department: ...................................
Building, Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Roofing
......................................................................................... REC-11999-000345
PaidBy: ....................••..••............
Paid in Full On:
Quinlan Builders
................. ....................................................................... Wed Aug 12,19
98
.. . ...... ......
Received By: .Check. . .No:--------------
Linda Lapointe 2006
.........................................................................................
......................................
DEPARTMENT'S COPY Amount: $20.00
...........................
RU',111ARTMENTFILE COPY 48 ELIZABETH 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: Inspector: Tracking No.: Fee:
12 Aug, 1998 BP-1999-0167 $20.00
GIS 9: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
4514 25C 134 001 48 ELIZABETH ST URB 3484.8
Contractor: License Type: Insurance:
Quinlan Builders CSL
Address: License No.: Insurance No.:
51 Mt Warner Road 053107
City: State: Zip Code: Phone:
HADLEY MA 01035 (413) 585-0949
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0290 roofing $4,300.00
Description of Work:
SHINGLE ROOF OVER I EXISTING LAYER
ISO 1997 Des Lauriers&Associates,Inc. Signature: