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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
,Q / � Garage
1. Location f 4y b yG"6 '"'-' Lot No.
2. Owner's name �r'G�/�/��°� �+F,ryr Address 5G
Address 3. Builder's name 9,0 ✓r1 tv i s J j
s 7► �(�' G
Mass.Construction Supervisor's License No. C7 1 Q J 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:- lbw 1 1 Z 1 d O
The undersigned certifies that the above statements are we to the best of his,
knowledge d be f.
Signature of responsible app icant
Remarks t, too , H S � �� l �/ / �9�'"l" �, T
a
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D,t'PARTMENT OF BUILDING INSPECTIONS
212*Main Street ' Municipal Building '
Northampton, Mass. 01060
WORICER'S COMPENSATION INSURANCE AFMAVIT
with a principal place of_�buslnesslresidence at:
H1`t (C1t & Y, - #0 , (phone#)f��5�3�
(strCWcity/stalrlap
do hereby certify, under the pains and penalties of pegury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Lamrance 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) Gmstiran(-- Company/PoEcy Number) (Expimtion Date)
(Name of Contractor) Grisui-ance Company(Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compa4y/PoUcy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional shcct ifnoccaary to incdudo inf(xm on pertain ng to all 00.t,, torj)
( ' 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 whilo hcmcotimcra wbo cxmptoy pa-;.am to do mxini�ozc=;t dionor repair work on a dwelling of
not moca than throe units is which the homoowocc rmdca or oa tbo grounds zppurtcn•"i thereto arc cot wally eoandcrcd to be
employers under tbo worker`s oompaasatica Act(GL152.ss 1(5)),appticafloa by n homeowner far a Haase or permit may evidence the
legal rtatus of an employer under tho Workcez Compomalioa Art.
I understand that a copy of this rulcmmt may be forwarded to the Dtpertc�of Inh tstri d Axidee&Office of Imw=-for the
--age vcrificstioa and that kd=to soeure ooverago tnrdcr soctioa 25A of MOL 152 can lead to tbd imposition of aimi=l penalties
oomisiiag of a fine of up to$1,500.00 uxSlor irnprisoaaxct of up to one year and civil pmattia is the form of a Slop Work Order and a
fim of S 100.00 a day against mc.
For dq=tmer¢i1 uao oaly
Permit Number
Ma Lot
p# #
4Sinature of Lia�scelPcrndt t=
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 COMPLE'T'ED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
Thia ccluam 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
# of Loading Docks
Fill:
A volume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge LLL
DATE: 6, 40 —9� APPLICANT's SIGNATURE
NOTE: lasuanoe of a zoning permit does not relieve an appl' ants burden comply witta_all
zoning requir�aments and obtain all required permits from the Board of H alth, Conservtation
Commission, Department of Public Works and other applionble permit granting authorities.
FILE #
JUN (
File No.
PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: Qi"'1 wom �14
Address: Vs S rye ��` Telephone:
c
2. Owner of Property: FrR'? J /�Y o/11
Address: /J/ 141I Cl vc�O'! /�G/ Telephoner`!
3. Status of Applicant: yOwner Contract Purchaser Lessee
Other(explain):
4. Job Location: 5c"1,
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5, Existing Use of Structure/Property
6. Description off Proposed Use/Wor JProjef ct/Occupi a on: (Use additional sheets if essa-1-
S Er, rob 4w/b f /
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 PermitNadance/Finding ever been issued for/on the site?ia
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)
151 AUDUBON RD BP-1999-1070
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 05-047 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:roofing BUILDING PERMIT
Permit# BP-1999-1070
Project# JS-1999-1794
Est.Cost: $6320.00
Fee: $20.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Quinlan Builders 101707
Lot Size(sq.ft.): 82764.00 Owner: FAIVRE FRANKLIN R&MARY E
Zoning:RR Applicant' Quinlan Builders
A_ T: 151 AUDUBON RD
Applicant Address: Phone: Insurance:
5 Hillside Dr (413) 585-0949
HADLEY 01035 ISSUED ON.'611111999 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & 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 6/11/1999 0:00:00 $20.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo