25C-197 (3) a
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/ Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. ���' �'`��� Alterations
NORTHAMPTON, MASS. / 1 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
a Garage r/j
1. Location to(5-
Y V L��Tr <% Lot No.
2. Owner's name &A/
3. Builder's name � ; l >�y f?7T 0,2 Address 3 1--..( < 7-,
Mass.Construction Supervisor's License No. 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�� o e- lZ 4 n 6 66 j't
13. Siding house
14. Estimated cost
The undersigned certifies that the above statements are we to the best of his, her
knowl d beJ�
Signature of responsible app,icant
Remarks
O O
9 B Aasaxchctsc[to
OCT
� DEPARTMENT OP BUILDING INSPECTIONS
^K212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S CONlTENSATION INSURANCE A-Fir' DA.VTT
I _
(li�ns�x/permi tree}
%,nth a principal place of business/residence at:
LAu&a- (phoneio
(sti��t/city/sta tP1 a p)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the follotiVing worker's compensation coverage for my
employees workdng on this job. .
(1nS;u=c,; Company) (Policy 2,11umber) (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:
F)11C
nil�'1'71i�C1
)
� aIIIC
of Cotl(iici0r)
(Name of Contractor) (Insu=, cz Compi-ayiPoLcy Numbu) (EspLration Date)
(Name of Contractor) (Insurance: Comp,,_uy/Policy Number) (Expiration Date)
(atladt aciditiocid zhcct if nc� to incJukk iafcmtstica pcstiinir�n to all ocrt-ac14n)
(<—I am a sole proprietor and have no one work no for me.
( ) I am a home owner performing all the work myself.
NOTE:plcaae be aware that whilo hca ,Amcr3 wbo canploy pccroas to do m-tint=u coal udico or F Pair Nvork on i d c l rig of
not moce than threo units in u',uch the home 7ocr r=idn or oa the grmtrx s app tan ui tbccto an no(gcocrally eomidcrcd to be
cmploym undcr the vror .t«mpc 4cn Au(GL152_,�s 1(5)),appLiraflon by a homcowvcr for a liccnso cc permit may cvidcncc the
legal rtahta of an employor undrr dh Woriccic Compcoaation
I undar t=d thzt a oopy of thi.rrit.®mt m..y bo forwvrd.od to the Dcpnrtmcni of Industrial A.c6dco&OfSoo of Irx-for the
coverage vaific iioa and that fail=to s utre covecnga under seetioa 25A of MGL 152 can lid to tbd imposifioa of a'Minil pea'dEcs
ooauxtnig of a f nc-of up to S 1,3 00.00 and/or irl�nt of ip to one yvr and civil pcmltics io the foam of a Stop Work Order and a
"ofLiccnsec/PcnniUcc
For dcparibtcotal tn only
Pcnait Number
Lot#
Mite
4
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 —In= to be filled in
by the 8ai1ding Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lotarea minus bldg
&paved parking)
# 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 k owl ge
DATE: 1 APPLICANT's SIGNATURE
NOTE: l"u no of a zoning permit does not relieve an plioan s burden to oomply wltlp AMU
zoning require ants and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
� .
I 1
p File No. W
3 m `
I} { i r £
f 7
�V 4�S'�rh 4i, A,H
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: �y/F) 't6 .4 U1T_1L
Address: '�oLE g4I'2Lzj, &rt Telephone:
2. Owner of Property: A&''y
Address: tog.- 100&_ q cz Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain) )
4. Job Location: CQ � /L)o/' 4 `
Parcel Id: Zoning Map# --� �' Parcel# 7 District(s): /� C_
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed UseMlork/Project/Occupation: (Use additional sheets if necessary):
L t,2 19ef" 01-19 621�4
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/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)
Department: Reference No: BP-1999-0363
...................................
Building,Electrical & Mechanical Permits
Fee Type: Receipt No:
Roofing REC-1.999-000956
Paid By: Paid in Full 0 n
David Fortier Wed Oct 07,1998
..................... ...................................................................
......................................
Received By: Check No:
Linda Lapointe 2651
....................:-...................................................................
.......................•..............
DEPARTMENT'S COPY Amount: $20.00
...........................
DEPARTMENT F.1 LE COPY 65 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:
07 Oct, 1998 BP-1999-0363 $20.00
GIS#: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
4573 25C 197 001 65 NORTH ST URC 6403.32
Contractor: License Type: Insurance:
David Fortier HIC
Address: License No.: Insurance No.:
32 Laurel St 103999
City: State: Zip Code: Phone:
NORTHAMPTON MA 01060 (413) 586-8965
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0738 roofing $6,600.00
Description of Work:
STRIP & SHINGLE ROOF
GeoTIVIS@ 1997 Des Lauriers&Associates,Inc. Signature: