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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. � ' �LI Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location c�S� S��t ��t>;A e� 't�N Lot No.
2. Owner's name �- `` Address
3. Builder's name bJC,llr:ls'nl # S ." Address CCACX k Sf r
Mass.Construction Supervisor's License No. Expiration Date C)CA t 9
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 `�" r`� =Ik
13. Siding house
14. Estimated cost:- �10
CJ The undersigned cer ies that th above statements are we to the best of his, her
knowle a and i f.
Signature of responsible app4icant
Remarks !Q
o4CHAMp�O
B ��� ' ` �, lJ ja54RCl�ItS[ttD r
u, m 1yVA TMENT OF BUILDING INSPECTIONS
•121Z"Main Street e Municipal Building
Northampton, Mass. 01060
WORKER'S COPrITENSATION INSURANCE AT' t AVIT
(li c�nsec/pernv uee}
with a principal place of business/residence at:
(phone#)
(St!=/city/sta&z:ip)
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 worlang on this job:
(Insurance Company) (Policy Number) (Expiration Date)
I a sole proprietor general contractor or homeowner (circle one) and have hired
the contractors st ow who have the following worker's compensation policies:
(Name of Contractor) (Insurancc Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compaay/Policy Number) (Exp,ration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(s"adr add?dccal sheet if noccss to include informitioa pertaining to all CC"f�r3)
Q�1 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 tbat whilo homcowvm wtw co3ploy perzom to do mxiuf�amsiruc6oa or repair work on a dwelling of
not morn than throe units in which the hornoowv rcxidn oc oa the grouad3 appurtmn tharto arc not CcrallY oomidacd to be
employ=under the worker's.compcssalion Act(GL152,s 1(5)),application by a homcowacr for a liccase cc prrm may cvid—the
legal etahra of an employor under tho W"kcea Cornpemaiioa AeL
I understand thst a copy of this stat-it may bo forwn iod to tho Depertascod of Industrial Arxadcacts Off oe of rnsuranoe for the
coverage verification and tbat failure to stxure coverage under sc;cUoa 25A of MGL 152 can lead to tho'imposilioa of-h aal pcna -
comistiug of a fine of up to S 1,500.00 and<or impriso�of tip to one yar and civil penalties in the form of a Stop W oric Order and a
firm of 5100.00 a day agaimt ma
For dePRtM=W use oaty
W _ f� Permit Number
1�,1 tj Ivfap#� Lot#
Signature of LiccnsWPermitiee
10. Do any signs ebst 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 cols 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
f of Loading Docks
Fill:
4vo1-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowl dge
DATE: Q APPLICANT'S SIGNATURE
NOTE: lasuanoe of a zoning permit does not relieve an applioanra b den to oomptj Wlt47'all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appiioabla permit granting authorities.
FILE #
z
SEP 1 5
Fi 1 e No
i
NON 'NG PERMIT APPLICATION (§10 . 2
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: A fl,�Cnm ",
Address: JS �{�Vq� S� �A5��2H-nroL- Telephone: c�
2. Owner of Property: t'-1 �rOSi
Address: qa- 221QSQr', S1 � �J, 1Coti Telephone:
3. Status of Applicant: Owner _Contract Purchaser Lessee
Other(explain):_ QQr\�,uC—AorL-
4. Job Location: g� I��i�S��S S1
Parcel Id: Zoning Map# �- Parcel# District(s): l�)-.-4Q4
(TO BE FILLED IN BY THE'BLJILDING DEPARTMENT)
5. Existing Use of Structure/Property S lh
6. Desc(�'
S�t ption of Prop, �
sed se ork/Project/Occupation: (Use additional sheets if necessary):
� ,
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 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-1999-0297
Department: ...................................
Building,Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Roofing REC-1999-000751
......................................................................................... ...... ...............................
Paid By: Paid in Full On:
Ducharmv & Son Construction Tue Sep 1S 1998
......................................................................................... ......................................
Received By: Check No:
Linda Lapointe 1.245
......................................................................................... ......................................
DEPARTMENT'S COPY Amount: $20.00
.......................••..
DEPARTMENT FILE COPY 82 PARSONS 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:
15 Sep, 1998 BP-1999-0297 $20.00
GIS Man Block: Lot: Address: Zoning: Use Group: Lot Size:
4552 25C 176 001 82 PARSONS ST URC 7579.44
Contractor: License Type: Insurance:
Ducharme & Son Construction HIC
Address: License No.: Insurance No.:
15 Gaugh St 118101
Liy_i State: Zip Code: Phone: -
EASTHAMPTON MA 01027 (413) 527-8940
Proiect No: Category-y of Work: Const. Class: Cost Estimate:
JS-1999-0624 roofing $4,600.00
Description of Work:
STRIP & SHINGLE ROOF INCL PORCHES
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: