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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER a Repair
Garage
1. Location b S Lot No.
2. Owner's name TOM Q t -v/ZAl S/Z is M Address SA>v\F AS' Afla 05 l
3. Builder's name ��1�/�1/I!� 7,- Colel7 7T Address (g/ f3llc��iY�i�rF �vE X, 4L
Mass.Construction Supervisor's License No. /�� //9 SASS' Expiration Date 7
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 ,J? o 1
13. Siding house
14. Estimated Cost:-
L)v
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
Signature of responsible app,icant
Remarks ,Ldl/�� '09,i49 rill
4� k
rip O
B !1v"' � , , �x34RCh2iSttt4
, �-DEPARTMENT OF BUILDMG INSPECTIONS
212 Main Street e Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFMI AVIT
rC tom.`2l
(licensec/pelm i flee)
with a principal place of businesslresidence at:
6/ 6feo6 K�� �lii ��d��f; ��c�</d (phone#)'=
(str�i/ci ty/st ate/n p)
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 worlang on this job:
(Insurance-- Compa-ay) (Policy Number) (Expiration Date)
O I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the folloWiMg worker's compensation policies:
-! - --
^� p � �2vc J t�a�v /��c�r/�r✓ rS� _ S T� c_��.V%nL,IU
> jL f
( Tame of C on ractot) C�nic��rt�,Poticr N�sntcr� E1�pilndon Date)
of Co-1 "actor) D,
(Name of Contractor) (Insztranc� Cou1llany/P0110-Nulllb,�11) (Expiraton Dale)
(Name of Contractor) (Insurance Coml-,, Policy Numb-�r) (Expiration Date)
(auac�zcSiiticail s5cct ifncccaary to inC}Ut}c infonnatiw pctai�in;to nll ccdrsc'�n)
( ) 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 wElo homenwvm wtho c=P!Oy pcczo=to do nui �c,0=str tioa ar repair work oo a dwelling of
not mete thin thtco units is wfnch the bomeonncr rtndci cr oa fix gzotrorh appurtcn th a-do n.'c pot 6—-lly ooasi&rcd to be
employes under tho worker's ssatien Act(GL152,sa 1(5)),application by a homeowner far a 130=se cc permit tnay evidc—the
legal rtatua of an employer under the Workces CoaVtc .lion Ace
I unda-j i d that a copy of thin rtst�atay bo lorarrded to tho Dtpnrtmcat of Industrial Attidrnt�Of oo of Inauinco for the
coverage vaificatioa and that fail=to secure coNttngo ttndcr sectioa 25A of MGL 152 can Icad to the impose -of criminal pcnalt;a
comisaMg of a fine of up to S 1,500.00 XrW0C imprizoatncat of tip to one y=and civil pmaltits in t Ic form of a Stop W or!c Qtdcr and a
fitzo oCS100.00 a day against mc.
For dcputmcrbl uao only
Permit Number
MCI#
Lot#
Signature()f-Ljccnsce J crnuttcc --r -
l:
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 cclm= 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
f of Loading Docks
Fill:
(vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: / ' APPLICANT's SIGNATURE
NOTE: laa anoe of at zoning permit does not relieve an applioant's burden to oomply withl7011
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 #
ri-4
L � aLA3 2 1
DEPT OF G!. File No ��
IdGfiTi- s
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: F-Pml lw %
Address: ��/ ��a1f�, � A� /64.- Telephone:
2. Owner of Property: / u'j
Address: i( c Telephone: 16C10
3. Status of Applicant: `,Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: /r� /✓ /a �����
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupabon: (Use additional sheets if necessary):
C-( v
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 !U 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-1999-0226
...................................
Building,Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Roofing REC-1999-000465
.........................................................................................
......................................
Paid By: Paid in Full On:
Edward T Corbett Fri Aug 21 1998
.........................................................................................
......................................
Received By: Check No:
Linda Lapointe MONEY ORDER
.........................................................................................
......................................
DEPARTMENT'S COPY Amount: $20.00
...........................
I)EPARTMENT FILE COPY 50 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:
21 Aug, 1998 BP-1999-0226 $20.00
GIS #: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
1772 17C 139 001 50 NORTH MAPLE ST URB 13590.72
Contractor: License Type: Insurance:
Edward T Corbett HIC
Address: License No.: Insurance No.:
P 0 Box 6241 119488
Lilty-i State: Zip Code: Phone:
HOLYOKE MA 01041 (413) 585-0953
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0394 roofing $5,000.00
Description of Work:
STRIP & SHINGLE ROOF &REBUILD CHIMNEY
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: