17C-078 (4) �o
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CIL
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. Ao,-/ / ��`� 19 Additions
'
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location ' Lot No.
2. Owner's name Address
3. Builder's name �-� ,� + �� Address
Mass.Construction Supervisor's License No. .CJs i. 0. Expiration Date
4. Addition
5. Alteration 7"' .1a V 2 k
6. New Porch l
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
14. Estimated cost:-
-
The undersigned certifies that the above statements are we to the best of his, her
knowledge and lief.
Signature of responsible app,icant
Remarks vt1 cz �' '
�O�KTO�
51998 $1:sstschtssctta
u, DEP TMENT OF BUILDING INSPECTIONS
�.. Ll� Main Street Municipal Building '
Northampton, Mass. 01060 V
WORSCER'S CONLPENSATION INSURANCE A t t AVTS'
(licen_secJperrni ttec)
%tnth a principal place of businesslresldence at:
I't- f 7i,! (Phone#)
(stl t/city/SUIFJ2�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 worldng on this)ob.
(a.,;u=ce Compa-ay) (Policy?;umber) (Expiration Date)
(✓�am a sole�FOpnetor general contractor or homeowner (circle one) and have hued
the contractors listed below who have the following worker's compensation policies:
(, III( Of Co"Im'Ictor) (In__ ?C Co III Dam'/toh,—r LIlrCr) J Con Date)
(Maine of Contractor) (ZJLs_:ace Coil]D.::ri'%PO!)C; Numt-'r) Date)
(Name of Con.tractor) (Lnsumnce Compaay/Policy Numbu) (F-\p.,ra6on Dale)
(Name of Contactor) (Insurince Compaay/Policy Number) (Expiration Date)
(att�� additicc¢d zbcct ifnccca-iry to i-Jude pertti-cung to all ccc rat' n)
(Cf"I am a sole proprietor and have no one wor4-ma for me.
( ) I am a Horne owner performing all the work myself.
NOTE:plcasc be awirc that w1iJo homcowmcrs H bo cwploy persom to do tnaia�mmtuction err repair worst on a dwclling of
not moca than thtuo units in wtuch the bomooavcr rcudn oc oc the ground,;ppukn".t tl�,to arc oot gcocrally conwidcrcd to be
cmploym under tho w%kcr'i oompc=atien Act(GI-151,s 1(5)),,application by a homcoa-0cr for a license cc permit may evidence the
1ega1 ctahie of nn amployoe under tho WoricerL CompcosLtioa Actt
I undcrstind that a copy of thin mtcmcas may bo fc -ardnd to tha Dcparmxvd of In!atrial i�nadcai�Off o0 of Irsxvaocn for th,
covcrxge vrtifieatioa and that failure to uxL=co-vtmV under section 25A of MOL 152 tin lsd to tbd impostion of criminal pcaslties
ooasisting oC n-fine of up to S 1,500.00 and/or irop isoamcai of tip to one ycar and civil pcmltics in the form of a Stop Work Order Lod a '
find 0(5100.00 a day against tL
r Foe depsr�u'o only
i' Permit Number
Iviagll Lot# 1
Sipn�lhtzi;of iccnsccJPermittcc
10 Do any signs exist on the property YES NO S _
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 colnmm to be filled in
by the &wilding Aepnrtment
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
&pared parking%
# of Parking spaces
ht of Loading Docks
Fill:
-(volume -& location)
13 . Certification: I hereby certify that the information contained herein
_a
is true and accurate to the best of my knowledge.
DATE: '/ `? y� APPLICANT's SIGNATURE
NOTE: Is anba of at zoning permit does not relieve an an plio is bur en to oomply with ali
zoning ulrements and obtain all required permits from th Board of Health, Conservation
Commission, Department of Publio works and other appiioable permit granting authorities.
FILE #
N
`i.: NOV 5 1998
File No.
sea
PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: r; _ ) } `� ��°
Address: �> Telephone: ���
2. Owner of Property: =R
Address: ' Telephone:
3. Status of Applicant: Owner Contract Purchaser L/ Lessee
Other(explain):
4. Job Location: <<''
Parcel Id: Zoning Map# Parcel# O District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5, Existing Use of Structure/Property � )40 F
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
4(jo f I?L�'c° i/Lq' !P
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 PermitNadance/Finding ever been issued for/on the site?
NO DON'T KNO!A: (l/ YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW f✓ 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-1999-0471
Department'. ...................................
Building, Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Roofing 111j'A999-001273
................................................ ............... ...... ................. ......................................
Paid By- Paid in Full On:
George 'rhibodo Fri Nov 06,1998
......................................................................................... ......................................
Received By: Check No:
Linda Lapointe 1806
......................................................................................... .................................DEPARTMENT'S COPY Amount: $20.00
----------- - ----------
l)l1.',PARTMFNTFl1A.1 C'011A' 35 HIGH 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:
06 Nov, 1998 BP-1999-0471 $20.00
GIS 4: Map Block: Lot: Address: Zoniny,� Use Group: Lot Size:
1713 17C 078 001 35 HIGH ST URB 8929.8
Contractor: License Type: Insurance:
George Thibodo HIC Workers Compensation
Address: License No.: Insurance No.:
177 Park Street 107483 Commercial ins
Li!E State: Zip Code: Phone:
EASTHAMPTON MA
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0904 roofing $3,480.00
Description of Work:
SHINGLE ROOF OVER I LAYER
GeoTMS&1997 Des Lauriers&Associates,Inc. Signature: