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!� Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. — 'y�' Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
—T
1. Location Z C�� �- ,`r 1 (Y%JP 6 0 Lot No.
2. Owner's name l L� 'c� r. , (�F�F,(--CSkddress�
3. Builder's name �'T �� C BFC—C6Address
Mass.Construction Supervisor's License 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 c<, � 2c�nF n( )�
13. Siding house
14. Estimated cost
(!✓� The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
Signature of responsible Ippicani
Remarks
4�1tA1dpT
� .0° QZ't Mllt (Ill -
a � �aSflACIjBSC1t5
IJEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S COiYIPENSA`ZION INSURANCE Ar, AAVTr
(li censee/permi ttee)
with a principal place of business/residence av
6Q (phone#)
(strt"i/ci ty/statr/�p)
do hereby certify, under the pains and penalties of penury, that:
O 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) (Insumnc; ComRany/Potiq Number) (E-xpimtion Date)
(Name of Contractor) (Insurance Company/Polio-Ni u nber) (Expiration Date)
(Name of Contractor) (Insurance ComparylPolicy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(aaach additioml sheet ifnoccKary to mchuie informaf pertairnng to all cocrtracto s)
(�,Kl 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 whilo bomeow me w•bo employ pazom to do m*iat M•nce coast ioo or repair work on a dwelling of
not morn than three units m which the homeowner reside or oe the thaeto arc not ra11y 0003idacd to be
employers undo the worker's comps silion Act(GL152.ss 1(5)),application by a homeowner for a license or pum):d maY evidence the
legal etatua of an employer under tho Woriulr Compomation Act
I undcrsUnd that a copy of this ctatcanmt may be fbrwurded to tbo Dtportmcn2 of Indw tri al Aocidca&OfSoe of Iuwnnco for the
covers verification and that failure to secure coy under section 25A of MGL 152 can toad to the imposition of cnmmsl Penalties
coa sting of a fmc-of up to S 1,500.00 andlor imprisonaxut of up to one year and civil penalties in t6c form of a Stop W orit Order and a
find of 5100.00 a day 1pi-t me.
Foc dgMt>�al—only
Permit Number
Map# Lot#
Sigaabne of LicenseelPermittee
i�
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 column 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:
(Lotarea minus bldg
&Paved parking)
# of Parking Spaces
#- 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.
D?II E j APPLICANT's SIGNATU ✓� �` ' _�G6t-�
NOTE: laeua oe of a zoning permit does not relieve an appiioant'a burden to mply mgt4 au
zoning rements and obtain all required permits from the Board of Health. Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
FILE #
q.,
AW
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: Y't GV�-��'� 6 'K'
Address: �_� �, \ f 1 Telephone:
2. Owner of Property: Y1�\\ C,�1 ��� al, (L)�'���
Address: 17 s Ny- \ \ Telephone:
3. Status of Applicant: ✓Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
S. Existing Use of Structure/Property J � `\,
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
Q klcx r,-Q- ( 1'L� r_3 AA
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 L'-- YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
1
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 v 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-1999-0180
Department: •..................................
Building, Electrical & Mechanical Permits
.........Type:ype: Receipt No:
Roofing REC-1999-000373
Paid by: Paid i n Full 0 n
Michael Capers Fri Aug 14,1998
........................................................................................ ......................................
Received By: Check No:
Linda :Lapointe 531
......................................................................................... •.•.........•.................•••.....
DEPARTMENT'S COPY Amount: $20.00
. ..............
DEPARTMENT FILE COPY 125 NORTH 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:
14 Aug, 1998 BP-1999-0180 $20.00
GIS Map Block: Lot: Address: Zoning: Use Group:, Lot Size:
4549 25C 173 001 125 NORTH ST URC 6098.4
Contractor: License Type: Insurance:
Michael Capers CSL
Address: License No.: Insurance No.:
125 North St 071965
Liy-i State: Zip Code: Phone:
NORTHAMPTON MA 01060 (413) 585-1091
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0319 roofing $600.00
Description of Work:
SHINGLE ROOF OVER I LAYER
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: