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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. ®® Alterations
NORTHAMPTON, MASS. 19/ C, Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1.
a!/� 6 T F/o 12 rt G� r
Lot No.
2. Owner's name MAP 7'l s�i9 Address //0
11�t1 In r9 J/r 5,7 � 1,e-, �Gl e Z
3. Builder's name Address A'A Ta#j ')7119
Mass.Construction Supervisor's License No. Expiration Date _ t?• �� n
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
13. Siding house Z/f Jt✓y I 1t'�r )0
14. Estimated cost:- Lt OQ
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature o responsible appicant
Remarks
4�ttAMp�,
a Crrf laf Naztljalitptoll
JUL2 81998 asaxrEJnsrus
�j r'�"�"- ° g DEPARTMENT OF BUILDING INSPECTIONS
m bE cir
eft ''i4 212 Main Street ' Municipal Building
Northampton, Mass. 01060 y
WORKER'S COWENSATION INSURANCE •1 MAVIT
(li cen_serJpermi ttr_c}
with a principal place of business/residence at:
410 f'lA4 ?�)0 >V A'� (phone#) �� t� 167
(&t1-C_-t/citY/ , aP)
do hereby certify, under the pains and penalties of perjury, that:
(1/1 am an employer providing the following worker's compensation coverage for my
employee's working on this job.
j p�'S 6V n) f 5 o A L,_t' 10)� (6 7 4
(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 Compauy/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/pohcy Number) (Expiration Date)
(Name of Contractor) (Insurance Compaia/Pobcy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additioml short iFncccaary to include informitioa pertaiuing to all cc"rnttnrs)
( ) 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 that whilo homcoµmxra wito employ pazom to do amica3-n o,cooSt uc oa or repair work ou a dwelling of
not more then throe unttt to whrch the homrovmcr rcudca oc ou the gruunris appurteaani thereto arc oo(geaer>iRy ooasidaed to be
employers under the worker's dim Act(GL152,s 1(5)),application by a homcowncr for a license cc permit may evidcaa the
legal datua of an employer under the Worlceet Compmsalioa Act
I understand that a oopy of this ruicmmt may be forwarded to tho Dcpa�of Indauf d AcadM&Oltioa of Inv unnoo for the
coverne verifieaiioa and that failure to aeatre covcrago undrx scetioa 25A of MGL 152 can lead to tba itmmpos Oa of-initial peaa -
oomistnmg of a fine of up to S1,500.00 aadlor itulttisosmcs3 of tip to one year sad civil pmaltia in the form of a Stop Work Order and a
fine of 5100.00 a day against me
For&Put=tfil uao—1Y
permit Number
: 2, Map# Lot#
Signabrre of Lic=se&Permi
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 —1== to be filled in
by the Budding Department
Required
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 parkingi
# of Parking spaces
#` of Loading Docks
Fill:
{volume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: jV1 9'� APPLICANT's SIGNATURE ��,�
NOTE: Issuanoa of a zoning permit does not relieve an appltoanYs burden comply with) .a11
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission. Department of Publio Works and other applioable permit granting authorities.
FILE #
FP� 111 tl�
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATI,OQN
1. Name of Applicant: 5�,d/eU�� 1'�t%C' � �c," '►J
Address: 7,91 �') � Telephone: wig( 1167
2. Owner of Property:
Address: //OPr�/t rjT ��4✓C Cr���C �����elephone: �l�- �` ��
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(/explain):
4. Job Location:
Parcel Id: Zoning Map# Parcel# A2 District(s): -
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property :7 a4"
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
V s;,-,?/ x>C .,
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)
Department: Reference No: BP-1999-0125
Building, Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Vinyl siding
......................................................................................... REC-1999-000202
PaidBy: ............................
13 & R Siding Paid in Full On:
Tue
......... ......................................................................... Jul 28 1998
Received By: ... ..................................
Linda Lapointe Check No:
......................................................................................... 16135
......................................
DEPARTMENT'S COPY Amount: $20.00
...........................
DF"PARTMENTFILE COPY 110 NORTH MAPLE 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:
28 Jul, 1998 BP-1999-0125 $20.00
GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size:
1651 17C 016 001 110 NORTH MAPLE ST URB 21387.96
Contractor: License Type: Insurance:
B & R Siding HIC Workers Compensation
Address: License No.: Insurance No.:
781 Bridge Rd. 100465 10000280A
City: State: Zip Code: Phone:
NORTHAMPTON MA 01062 (413) 586-4167
Proilect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0166 vinyl siding $8,500.00
Description of Work:
INSTALL VINYL SIDING
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: