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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
40 Garage
1. Location Lot No.
2. Owner's name Address yi
3. Builder's name Address<--J
Mass.Construction Supervisor's License No. Expiration Date
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 app.icant
7
Remarks _7
�0 0
� 5 rZ� of Nort 4aillpfrill
. ;°J9g way
$ � � �lxsaacfinsrtfa
DEF14F't;' PARTMENT OF BUIWING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AF'EDAVTT
i
I, t° '
(li censee/permi tree)
with a principal place of business/residence at:
(phone#)
(sheet/city/stat&2ip)
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 working on this job:
(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 Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additioml shod ifneocsary to incline infwma2ioa pining to all coatractors)
O 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 while homeowners who employ persons to do maintenance,eoastrud on or repair worse on a dwelling of
not more than three units is which the homeowncr rtudes or on the grounds appurtenant thereto an not gascraily oowidcred to be
employen under the worker's.compensation Ad(GL152,ss 1(5)),application by a homeowner for a license or permit may evidence the
legal ctatua of an employer under the Worker's Compemation Act
I undrniand that a oopy of this rtatement may be forwarded to the Deportment of Indi3trial Ac6dea&OflSoo of Insumoce for the
coverage verification and that failure to sea=ooversrgo under section 25A of MGL 152 can lead to the imposition of criminal penalties
oousistarg of a fine'of up to$1,340.00 and/or of up to one year and civil pcmzWes in the form of a Stop Work Oros and a
fine of S100.00 a day against tne.
/ For de pataxmbl use only
Permit Number
Map# Lot#
Signature of Li ermiU= Lace
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 D.EAIED DUE TO
LACK OF INFORMATION.
This cola to be filled in
by tbs 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)
# .pf Parking Spaces
i of Loading Docks
Fill:
4vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
D7ffE: APPLICANT's SIGNATURE
NOTE: Issuanoe of a zoning permit does not relieve an applioanYs bu en to comply witip,all
zoning requirements and obtain all required permits from the Board of Health, Cohaervtstio;
Commission, Department of Publio Works and other npplionble permit granting authorities.
FILE #
tnno g;
5 ITJV Fi 1 e No. J 1
°E OF M) ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: �(,i� �C��1�<
Address: ����. ,�v / �`D✓1 Telephone: o �z
2. Owner of Property: :4 4 rsc1 I-E
Address: -' /�'`% Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: /7 7
Parcel Id: Zoning Map# 1 Parcel# /53 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 necessary):
it .� ,�,, •- 4 ,/�
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 J 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: B.P-1999-0058
..............••.•.................
Building, Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Roofing REC-1999-000072
................. .......................................................................
Paid By: Pa.id..i.n.Full..0.n:...........
Scott Paquette.......... Wed ,Jul 15,1998
............................. ..................................................
.. . ...... ......
Received By: Check.No:...................
Linda Lapointe MONEY ORDER
.........................................................................................
......................................
DEPARTMENT'S COPY Amount: $20.00
-----------------REPARTMEW FILE COPY 95 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: Trackina No.: Fee:
15 Jul, 1998 BP-1999-0058 $20.00
GIS Mau Block: Lot: Address: Zoning: Use Group: Lot Size:
1766 17C 133 001 95 HIGH ST URB 33410.52
Contractor: License Type: Insurance:
Scott Paquette HIC
Address: License No.: Insurance No.:
58 Line Street 110223
City: State: Zip Code: Phone:
EASTHAMPTON MA (413) 529-2260
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0069 roofing $1,800.00
Description of Work:
STRIP & SHINGLE ROOF
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: