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17A-066 (4) • > > o v v o• � m .. .� LO Z © �• m 51 ^� Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MASS. s °`J 19 9� Additions APPLICa ATION FOR PERMIT TO ALTER Repair /� t Garage 1. Location �� �1 �/ 2.�/i�>^^ % r� P4 Lot No. � �' � 2. Owner's name Gy'AL-reG �' `r~ Address 3. Builder's name �°'` ' i� N �i ,� .�i�C-' Address ��r� /V6 ��"4"'" .Td Mass.Construction Supervisor's License o. d 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 A J An- .So '&� :X- �a 14. Estimated cost:-1�p Y,2()f�l The undersigned certifies that the above statements are we to the best of his, her knowledge and belief. Signatu a of responsible appicant Remarks WM L3 LS 8 5 FA ! Aas$achnsclls � Nov IY 1�.A n _ w m DEPARTMENT OF BUILDrNG INSPECTIONS 212 Main Street ' Municipal Building _ Northampton, Mass.' 01060 'y WORICER'S CONTENSATTON INSURANCE A t t AVIT I . 73 g ,-. 5,1 f e IV ri�' 51P--e, . 16 (linserJpermi tree) vrith a principal place of business/residence at: c% 'P (Phoned) , e._/'ld 7 city/stair/aP) do hereby certify, under the pains and penalties of pegury, that: (t4/I am an employer providing the follolvviog worker's compensation coverage for my ' employees working on this)ob: -foj� CA once 5`n %9 ds' (Insi=ce 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 workees compensation policies' Co, -actor) ,�liIlC�r) laon Date)O , - yL (N-mc of Contractor) (1-psu aocc COnloa1iNRO11cr NurIlC2r) (Esoimuou Date) (Name of Contractor) (LnaLranc-- Company/PoLcy Number) (Expiration Dale) (Name of Contractor) (Itsurance Company/Policy Numbe-0 (Expiration Date) (attach--Mitioaxl nccct ifnc<>a w indt>dc icfcrsna:icu pertlining w a oodradors) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:plcasc be awl c chit WE)a homcowvm Wtw a=ptoY pccsoar to do mx M^•^n ooastrUCtioa'or>�a work oo a dart &of not anoeo tban tbroo units is which the bam mcr tc=dw oc oa the v �-PP��� -1.oof Eby 000aidcred to be cmploym uodcr tba workr_z's oompc=-itica Act(GL152.ss 1(5)),applinDon by a homcovmv c for a Gomsc cc permit tnay cvidcncc tba legal rtsnu of an omployec undo tho Wockce&Cocapaos+t Act I uadastxnd that a oopy of.thia c t—nt may be fbmw r ed to the DcperCmcoR of ladautrW Aood�Moo of Iratx*toe foe tb+ covaige vaificstioa and that failtttc to scatrc a>vaaso undo sodioa 25A of MoL 132 can Irsd to tbo impost -of aimiD4 Pcasltia ` oo=stwg of a•fine bf up to S 1,5 oA and/oc improoamcat of tip W one ycr xod an7 pcmriia is the form oC a Stop W ork Otda and a find ofS1o0.00 a day against tnc Foe dcpctaxe tiao only, Peimit Number _ Siguahrzir tifI;ioasscelPeimi `_ . • . . .. .�-•-;,r.�,:c? -...SLt�''��41d9�fili3s!F'�,',��:.it,'1,...-.a, - ..��w'a"Y.7r.?.m:-:_c .+s.:. 10 Do any signs exist on the property? YES NO IF YES,describe size,type and location: tfk- 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. Thin cclum 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 # of Loading Docks Fill: -(volume--& location) 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. DATE: ���' APPLICANT'S SIGNATUREX-1— NOTE: Issuanoe of a zoning permit does not relieve an appiioanYs burden to 0o ply witla~4gtl zoning requirements and obtain all required permits from the Board of Healt , Conserrtation Commission, Department of Publio works and other applicable permit granting authorities. FILE # L� Fi l e No., Nq 'w ' t MV 5 ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: 79y e silk/y e,', S .1 ac, bit°1 "N L A �'``� Address: ? �' g�� � ° /�'lRdw 101L) Telephone: 2. Owner of Property:�Rl "� Address:, R-) Iydt 44�7�� _Telephone: 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): 4. Job Location: _ 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/Occupation: (Use additional sheets if necessary): T 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 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-1999-0476 Department: .................................. Building, Electrical & Mechanical Permits ......................................................................................... Fee Type- Receipt No: replacement windows REC-1999-001281 ......................................................................................... ..... ................................ Paid By: Paid in Full On: 13 & R Siding Fri Nov 06,1998 ..................................................................................... ...................................... Received By: Check No: Linda Lapointe 16306 ......................................................................................... ................................. DEPARTMENT'S COPY Amount: $20.00 ----------- -------------- IWPARTMENTFILIK COPY 256 BRIDGE RD 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: Trackinjz No.: Fee: 06 Nov, 1998 BP-1999-0476 $20.00 GIS Map Block: Lot: Address: Zonint!: Use Group: Lot Size: 1376 17A 066 001 256 BRIDGE RD URA 31101.84 Contractor: License Type: Insurance: B & R Siding HIC Workers Compensation Address: License No.: Insurance No.: 781 Bridge Rd. 100465 10000280A L!Ln State: Zip Code: Phone: NORTHAMPTON MA 01062 (413) 586-4167 Proiect No: Category of Work: Const. Class: Cost Estimate: JS-1999-0908 windows replaced $4,200.00 Description of Work: INSTALL REPL WlNDOWS,TRIB SOFFIT & FASCIA GeoTMS@ 1997 Des Lauriers&Associates, Inc. Signature: