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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 1 q Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location X02 e Lot No.
2. Owner's name U / Address l/2ef2 -_L..
3. Builder's name_ Address
Mass.Construction Supervisor's License No. n 10 7 V-10 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 A Ahl L -07.6 do I�
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 app,icant
Remarks
/ (rz of 'Wlart4 illiptoll
SD• � - i
9 'd'- �asaarEJttsttia -
�' 2 2
m PARTMENT OF BUILDING INSPECTIONS
DEPT Of BUIWW"N"G JN"Sz ECTi S 12 Northampton, Mass.tP 10601ding
NORTHAMPTON MX01060
WORKER'S COiYIPENSATTON INSURANCE ATTIDAVIT
(licenserJpermittee)
,vith a principal place of buSmess/residence at.
f •✓ W A' (phone#)
(stye e u ci ty/statehi p)
do hereby certify, under the pains and penalties of pedu y, that-
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) gixpiration 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 Comparsy/Policy Nusnbcr) (Expiration Date)
(Name of Contractor) (Insurance Companv/PoGcy Number) (Expiration Date)
(Name of Contractor) (Insurance Compariy/Policy Number) (Exp,rabon Date)
(Name of Contractor) (Insurance Compaay/Policy Number) (Expiration Date)
(snack additioaat sheet ifne,cessiry to mchxle iafo(m= —pataissing to all coatrnd4rs)
('--y"fam 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 homcoAsom who employ persoas to do *mfg-+•nn 000stuctioa at ruff work on s dwelling of
not Moro than throe units is wtuch the homoowucr residcn or on the grounds appurtcusnt thereto art oo(gwer9,dY 000sidatd to be
employes under the workct's comp� saticn Act(GL152,ss 1(5)),application by a homcownir for a license or patnil may cvidcnce the
legal ctahra of an employer under the Workeez Compmzation Act
I undastxnd thst a copy of this rtstcmcnt may be forsvcudad to the Dcgarta of lndusirial Aeadea&Offioo of Insucwnoo for the
covaage ver fienuon and that failure to sw=coverage usjcr seciioa 25A of MGL 152 can lad to the imposition of criminal pcnaltica
oonwt mg of a fine-of up to S1,500.00 andlor imprisotm cnt of tip to
one yar and civil pcaattia in the form of a Stop Work Order and a
firm of 5100.00 a flay against ma
For dirt nWW ttao�y
Permit Ntunber .
s �� Map# Lot#
Signahm ofL,iccnswJPermittee
r
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 cola to be filled in
by the Building Department
Required I
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L• R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parkirzgi
# of -Parking spaces
# of Loading Docks
Fill:
(vo1-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: 9 27' y APPLICANT's SIGNATURE G� �
NOTE: Issuance of a zoning permit does not relieve an applloants burden to oomply wit4-,an
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applionble permit granting authorities.
FILE #
022M
„_. Fi1e No
DEPT OF BUILDING iNSP E,.i
NOWA4MPTON MA 01V,0
n ZONING PERMIT APPLICATION (§10 . 2)
PLEASE' TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: 4/ 16a_� .S', % Telephone:
2. Owner of Property: /�G,� /,✓6�-1
Address: //z AltVe �'<�� Telephone: 6-t;71
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: _5
7
Parcel Id: Zoning Map# `d Parcel#_? District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/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/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-1999-0315
.........................•.........
Building, Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Roofing REC-1,999-000803
.........................................................................................
Paid By: Pa.id..i.n.Fu((..0.n:...........
....Ed.Corbett.Jr............................................................. Tue Sep 22,1998
................... ....
.• . ...... .....
Received By: Check. . .No:
Linda Lapointe 2878
.........................................................................................
......................................
DEPARTMENT'S COPY Amount: $20.00
..................
OEPAR,rMENTFILE COPY 12 MARC CIR
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:
22 Sep, 1998 BP-1999-0315 $20.00
GIS #: Map Block: Lot: Address: Zonine: Use Group: Lot Size:
866 12C 077 001 12 MARC CIR URA 14026.32
Contractor: License Type: Insurance:
Ed Corbett Jr HIC
Address: License No.: Insurance No.:
4 Reed Street 116069
City: State: Zip Code: Phone:
NORTHAMPTON MA 01060 (413) 584-6571
Proiect No: CateLyory of Work: Const. Class: Cost Estimate:
JS-1999-0653 roofing $4,100.00
Description of Work:
STRIP & SHINGLE ROOF
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: