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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. ��l Z-0 19 Additions
Repair
APPLICATION FOR PERMIT TO ALTER
Garage
1. Location �� <T19 irr b6ce*C t7,— Lot No.
2. Owner's name r Address
3. Builder's name tl Address �.1.
Mass.Construction Supervisor's License No. I/.��Iaz4j Expiration Date
6'/�v/x9e
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
14. Estimated cost:- �
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
Signature of responsible appican(
Remarks
y fr
�0GG36v°f ', 2 tJJV )!!! 1
,, g; :,, MAY 2 M (rxf >7fnxlJa»tnrl .
Q; casacansiIts
Ctf,
_.., .,.- DEPARTMENT OF BUILDING INSPECTIONS
212 Main Strect ' Municipal Building
Northampton, Macs. 01060
WORZCER'S COMPENSATION MSITRAIICE A AVIT
(liC�/peruvtLCC)
with a principal place of businesslresidence at:
CSC (pbooe,') r
(sue-(--vci tyiStLoaP)
do hereby certdfjy, under the pains and pt:nJbes of perjury, tbai:
( gym an employer providing the fo11o\\2)g v.,or-�er's compensation covet 2-c for my
employees wortanv oo this job:
I� �
(Insurance CoQpzuy) (POticy t.ttmber) ir-ation Date)
( ) I am a sole proprietor, geoeral contractor or homeowner (circle one) and have hired
the contractors listed below who have the following workers compensation policies:
(Name of Contamctor) QInsuranc-- Compau)•/Pobcy Numbcr) (F-cpi-m6oa Datc)
(Name of Cootrzetor) (Insurance C,0iBP ayi?obey Number) (EXp1m6oD Daic)
(Name of Contractor) (tnsur-,,nom Compza),/Poticf Numb J) (F-:aira000 Dalc)
(Name of Contractor) (Lastirmcz Compasy/Poky Numks) (Expindo❑Date)
(ettic3 additieml c?�e,if acoeiiry to ccUde iarorm.jeo pcs''�to..11 uxer-won)
( ) I am a sole proprietor and have no ooc worming for me.
( ) I am a-home owner perforTning all the work myself.
NOTE_pl—n be atrtrc t6*1 w�o bcc voce•+oo cloy pcziocs to&a iiz;�m�ca or rcpaff work-oo L(! <UiDF or
ant mock IL--n tbroo traits is ,t,z Ch the Fr_._.�o;.vcr r�i'c.o a co ebe p-ou��i zypuc4nj tbcetn u a.,e Eeaa-zlly mr_:idcrcd to be
cmplvym under tbo--Ot `z rim lei(G LI 52.n t(5) n p?Ucx6on by&bomcosrncr ror a Beam-or Pclmis msy-vile+«t5c
lcgp1 rt a"of a .cnxployec under ibo WOA—w ,Comparxi on Amt.'
I underst_d 6.t a Dopy of thin ,r,-...,..t_Y bo r«,4.d to tbo Dep—a tit of 1u S ,j iload—&Otboo of l�fx tse
eovc ge vecifiatioa and that Laihrre to smut covmebv uxy e4 so tioa 23A of MOL 132 can Lmd to tsd iatpnnhea ofcrimiatt Pens16ct
oomi:ang of••fsnc bf tap to S 1,500.00 and/or improoc-mcat of up to roc ycr and civil pcmh C3 in tsc form or n Stop Work. ' and a
ffno of S 100.00 a ly Lc inst.mc
' Signed this day of 1990 For dcpann�i1 tun Doty
Pcrmit Numbcr
MaPFI Lot iJ
Si of L'i crmit(pc
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 colt 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:
(Lot area minus bldg
' &paved parking)
# of -Parking Spaces
h� of Loading Docks
Fill:
(voi-ume--& location)
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
_1
DATE: - ZO APPLICANT's SIGNATURE
1" NOTE: issu no of a zoning permit does not relieve an applioanYs urden to Comply w it"
,,all-
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appliomble permit granting authorities.
FILE #
w 4
MAY 2 2 ,998 j l�
File No.
F
• ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: �1e / ��
Address: IcIC�a �'!C � Telephone:
2. Owner of Property:
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: 3t
Parcel Id: Zoning Map# Parcel# District(s)61e- -A
(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/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)
Pl 4l - � r FILE #
2 119%
MAP�LIC T/CONTACT PERSON: ��1v5
ADDRESS/YHONE: ZFiL-�
PROPERTY LOCATION: `
MAP J 7 PARCEL: 14 ONE G ,�-
THIS SECTION FOR.OFFICIAL USE ONLY:
PERMIT APPLICATION.CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM Vff,T.FD MIT
Fee P-gid
Fee PAid 5— �
u
1RPrnndPlin2 Interior
3 0
THE LLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
Approved as presented/based on information presented
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received &Recorded at Registry of Deeds Proof Enclosed
Finding Required under:§ w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
_8eplk'Approval-Bd of Health Well Water Potability-Bd Health
Permit from Conservation Co ission
Z
Signature of Building Inspec Date
NOTE:Issuanoe of a zoning permit does not relieve an applicant's burden to comply with all
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
M ,
Department: Reference No: BP-1998-0022
...................................
Building, Electrical & Mechanical Permits
Fee Type: Receipt No:
Roofing REC-1998-000025
Paid By: Paid in Full On:
Alan Shumway Fri May 22,1998
.................. ........ .........................................- y
.....---•-No:..•-•..............
Received By: Check No:
Linda Lapointe 1555
..........................................•-•------•--...................................
......................................
DEPARTMENT'S COPY Amount: $20.00
...........................
DEPARTMENT FILE COPY 41 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:
27 May, 1998 BP-1998-0022 Stanley Szewczyk 963572 $20.00
GIS #: Map Block: Lot: Address: Zonin Use Group: Lot Size:
1716 17C 081 001 41 HIGH ST URB 17903.16
Contractor: License Type: Insurance:
Alan Shumway
Address: License No.: Insurance No.:
625 pleasant street
gixi State: Zip Code: Phone:
AM][iER5T MA
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1998-0023 $750.00
Description of Work:
Strip and re-shingle front porch roof
GeoTMS 8 1997 Des Lauriers&Associates,Inc. Signature: