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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19�ff Additions
• APPLICATION FOR PERMIT TO A Repair TER Garage
1. Location Lot No.
2. Owner's name Address
3. Builder's name i Address
Mass.Construction Supervisor's License No. C.5 /� Ln 9�1 Expiration Da 4.3-6-:2:2
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 e s / e 7T
13. Siding house
14. Estimated cost-
The undersigned certifies that the above state nts are true to the best of his, her
knowledge an tef.
Signature of responsible appicant
v /eRemarks
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�l of 'Nart4aillvtov
8 d 4 Massachnsctts
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',DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street a Municipal Building '
Northampton, Mass. 01060
WORKER'S CO T'ON IN AFF'IDAVTT
Oicensee/perrnittee)
with a principal place of business/residence at:
se �//1/',?'—z (phone#) 7 7-�;
(strcet/city/state/ p) --7
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees worang on this job:
(Insurance Company) (Policy Number) (Expiration Date)
I am a sole proprietoreneral contractor or homeowner (circle one) and have hired
the rs sted below who have the following worker's compensation policies:
(Name of Contractor) (hisurancc Conlpany/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Potiey Number) (Expiraauon Date)
(Name of Contractor) (Insurance Comp.ury/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Comp<my/Policy Number) (Expiration Date)
(attach additional sheet Yneceniry to include information pertainuig to all«Yrtracton)
"Tam a sole proprietor and have n working for me.I am a home owner per ornung work myself
NOTE:pie=be aware that while hotneowntta who czaploy persons to do maintenaace coasuuctioa or repair work en a dwelling of
not more than throe units in which the homeo%v resides cX on the vvinasappurtenat the cto arc not ga)=Ry oomidered to be
crnployera under the workcr"axapat_saticn Act(GL 152—"I(5)�application by a homeowner for a license or permit may evidence the
legal stahra of an employer under the Workers Cormpeanation Act.
I underi d that a copy of this atxt meat may bo forwnnt«1 to tlw Dcpartam nt of In ustcial Aoci&at>'Ofsoo of lnwranco for the
coverage Ymfiicaiioa aad that fail=to sown covem9c to der section.25A of MoL 152 can lead to the imposition of criminal penalties
coasisting of a fine of up to S 1,500.00 and/or impriscximcz;t of up to 00C yrar exert civil Pmaltia in the form of a Stop Worst Order and a
firm o(5100.00 a day agsiwi me
Signed _day of =
For deprrttm"
use only
Permit Number
Map# Lot#
Sigma of LicenseeRcr=ttee
e
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 —.Iu= to be filled in
by the Building 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 parking)
# of `Parking Spaces
e fof Loading Docks
Fill:
4 voltzme--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowle
_y
D?II"E:ffltno4 APPLICANT's SIGNATURE
NOTE: f a zoni g permit does not relieve an ap lioant's bur an to oomply with_4211
zoning re ants and obtain all required permits from the Board of Health. Conservation
Commission. Department of Publio Works and other applioabla permit granting authorities.
FILE #
r1 F1
MAY 2 Q 199Q
File No.
ZONING PERMIT APPLICATION (§10 . 2
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: ` T /, / v J
� eephone:Address — S
2. Owner of Property: 7`
Address: P 737, o Telephone:
3. Status of Applicant: Owner Contract Purchasep,-Y—Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# -_ Parcel# A-2 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):
' od� -e
7. Attached Plans: Sketch Plan Site Plan ngineered/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 PermitfVadance/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)
A
96 CHESTNUT ST BP-1999-1000
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map•Block: 17C-086 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:roofing BUILDING PERMIT
Permit# BP-1999-1000
Project# JS-1999-1700
Est.Cost: $5185.00
Fee: $20.00 PERMISSION IS HEREBY GRANTED TO
Const.Class: Contractor: License:
Use Group: ROBERT D THIBODO 065699
Lot Size(sa.ft.): 11107.80 Owner: OLANDER JONATHAN
Zoning:URB Applicant: ROBERT D THIBODO
AT.• 96 CHESTNUT ST
Applicant Address: Phone: Insurance:
P 0 BOX 201 (413) 527-8966
NORTHAMPTON 01061 ISSUED ON.512611999 o:oo:oo
TO PERFORM THE FOLLOWING WORK.-INSTALL 1/2" PLY & SHINGLE ROOF
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Final: Final:
Rough Frame:
Gas Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 5/26/1999 0:00:00 $20.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo