17A-231 (3) OQ.'t�M�'TO
Grif� of
$ d �assachttartta -
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building '>o
Northampton, MA 01060
Applicant Information
Name —
Location ---h�-- ---_ ------ '
d.rGs�G ,y
❑ I am a homeowner performing all work myself
❑ I am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employees working on this job.
Company Name
Address
City—— __� � --- — — 86 77
— — one
Insurance Phone
#-- — ,, � �;,�� / �,• rA
Company Name
Address
City Phone#
Insurance Co. Policy#
gym
Failure to secure coverage as required under Section 25 A of IYIGL 152 can lead to the imposition of criminal
penalties of a fine up to$1500.00and/or one years'imprisonment as well as civil penalties in the form of a STOP
WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement maybe
forwarded to the Office of Investigations of the DlAfor coverage verification.
I do hereby certify under the pairs and penalties of perjury that the information provided above is true and correct.
Signature
Date JvN.t / S'
Print Name _'TA-x4 er5 —7—Ar—1 Phone> �{�3
Official Use Only Do not write in this area to be completed by city or town official
City or Town PermitlLicense 3F ❑ B-U-c Dept
Licensixti Bond
Check if immediate response is required
Sekctntax'Dept.
Contact Person Phone,# ❑
Health Dept.
limildo, Wilk AMA
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
I. 1-ocation y'7 �ff k F St ��-e a r WA Lot No.
2. Owners name --f—om Sf kew—c'�/ Address f7 �-Aks- ST `;/a
3. Builder's name J?Wee -r4:�FY Address A �l 61-etSe-e W7- ST
Mass.Construction Supervisor's License No. A164- Expiration Date
4. Addition Z Z X 4,
5. Alteration "
6. New Porch —f X /3
7. Is existing building to be demolished?
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating r� f
11. Distance to lot lines iJ o ��X a� �Q��/`t ArAro/Ir.a-T S 1 o e '2
12. Type of roof le
J°
13. Siding house
14. Estimated cost:- �( 6,9
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
signatu o responsible app icant
Remarks
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
11 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This columa to be Pilled in
by the Building Department
---
Existing
I
Proposed
-O
Kequlred
By Zoning
Lot size
Frontage
Setbacks
c�
- side
3
L: )"a R:
�
L: R:_�_
- rear
Building height
Bldg Square footage
�
MZ
- 30
%Open Space:
(Lot area minus bldg
&paned parking)
/�
o�
0o
# of -Parking Spaces
# of Loading Docks
Fill:
-(volume -& location)
tCl. L- L Uct L-Lull 1 nereDy certify that the information contained herein
G is true and accurate to the best of my knowledge.
_1
DATE: APPLICANT's SIGNATURE
NOTE ssuanoe of at zoning permit does not relieve an plioants burden to r� c�=Sewrttltxtiolln zoning requiremants and obtain all required permits f m the Board of Heal
iCommIns[on; Department of Publio Works and other applloable permit grant uthorities.
FILE #
JUN I Igg9
1 Q� DEPT'OF t3Ut{.Oi1�G I('�J�PEt;Ti(7NS
File No. NORTHAMPTON MAOIG,Q _
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: J40F,S /4-1-om
Address: /G f ('/ltrs'e--,�7" 571— Telephone: -f-,r3
2. Owner of Property: -/ OH s 6 ',q S/O"/-Telephone:
/
/
Address: 7 ���� s57-
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): �o� l�ei'12
4. Job Location: ��-
Parcel Id: Zoning Map# Parcel#_ District(s): C.tfi
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property R-esl,4,.711A-.
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
G -3-e l� Z z- '-Z>A/Pa
7. Attached Plans: _ y"' Sketch Plan V Site Plan ✓ Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
S. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO I/ DON'T KNO:A' 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)
File#BP-1995
APPLICANT/' f PERSON JAMES TACEY
ADDRESS/PI' ) CRESCENT ST (413)586-6451
PROPERTY 1. ON 97 LAKE ST
MAP 17A PA! 1 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FO i D O U T
Fee Paid _
Building Perri )[It_
Fee Paid
Typeof Const ONSTRUCT 2 STORY 22 X 16 ADDITION&4 X 13 PORCH
New Construc i
Non St ,ter rn���tirn;s
Additi - _
Access
Building Plane
Ownei M3666
3 sets e ! !
THE KLOI, ION H.AS P.FEN TAKEN ON THIS APPLICATION:
Approve Uli3c" 011 uuormation presented.
Denied it
to Plan Required under: §
?BOARD ZONING BOARD
Received Recorded at Registry of Deeds Proof Enclosed
.Jrk-,i �.1'. 3 w/ZONING BOARD OF APPEALS
-
�ceivedRRecordedatRegistryofDeeds Proof Enclosed
§ —w/ZONING BOARD OF APPEALS
cri veil ,� I --rded at Registry of Deeds Proof Enclosed
Othe;
:'. Water Availability Sewer Availability
!'Health Well Water Potability Board of Health
Commission
Signature of c._,. Date
Note:Issuan not relieve a applicant's burden to comply with all zoning
requirement !I lilt rec;a +permits from Board of Health,Conservation Commission,Department
of public wo armit granting authorities.
97 LAKE ST BP-1999-1019
GIS#: COMMONWEALTH OF MASSACHUSETTS
Ma -.Block: 17A-231 CITY OF NORTHAMPTON
Lot:-001
Permit: Building R
Category:alteration-addition BUILDING PERMIT
Permit# BP-1999-1019
Project# JS-1999-1729
Est. Cost: $46000.00
Fee:$251.60 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JAMES TACEY 003666
Lot Size(sg.ft.): 12937.32 Owner: STOKOWSKI THOMAS A&PATRICIA
Zoning.URB Applicant: JAMES TACEY
AT. 97 LAKE ST
Applicant Address: Phone: Insurance:
169 CRESCENT ST (413) 586-6451
NORTHAMPTON 01060 ISSUED ON.618/1999 o:oo:oo
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 2 STORY 22 X 16 ADDITION & 4 X 13
PORCH
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 6/8/1999 0:00:00 $251.60
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo