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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19— Additions
APPLICATION FOR PERMIT TO ALTER Repair
a Garage
1. Location Lot No.
2. Owner's name IJA&4—Ce Address T>AV-e--
3. Builder's name Address Ai;44 6>+ Pa%,4L,-,-,Lcj
Mass.Construction Supervisor's License No. a, jo d 71, 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 undersign ertifie e statements are true to the best of his, her
knowledge li
Signature of responsible app.icani
Remarks-
-
$
408
m DEPT
OF$U1:_F,;i6 FWsPECTj0NJgEP�IRTMENT OF BUILDrNG INSPECTIONS
NORTHA t;1- u N-1A GIC60 1
-21� Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFIt'IDAVIT
(1i ccrlser�permi ttee>
with a principal place of business/residence at:
i
�✓ yti 4� LS� L U-L,,4 -5 6-i �tn0�- b1lG`1G (phone#)y13 d=3S�`�
(street/ ' /statrJ�ip)
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:
(Ianuance 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/Poticy 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) irati
(Expon Date)
(attach-kHtioml sheet if noccsary to include infwmalioa pertaining to all contractors)
( 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 empiey persons to do maintenance,c=mvwon or repair worts on a dwelling of
not mote than throe units in which the homeowner resides or on the grounds apptuteau thereto arc not genaaily comide ed to be
employers under the worker's o=pcnsalion Act(GL152,-s 1(5)�application by a homeowner for a lioa>7c or permit may evidence the
legal status of an employer under the Wodcees Compomation Act.
I undrnla nd that a copy of this ttatommi may be forwarded to the Departmcod of Indrisnial Aecidea&OJ£oo of Imauanco for the
coverage verification and that failure to actor coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties
consisting of a foe ofup to 51,300.40 and/or kVrisomnerit of up to one year and civil penalties is the form ofa Stop Work Order and a
fmo of S 100.00 1,&Y against tae.
For depatwtaw urao only
Permit Number
Nf2p# Lot#
f'
of Liamsee/Permittee
a
�
�� x t
10. Do any signs exist on the property'? YES w 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 colu= to be filled in
by the Bui.ldinq Department
Required i
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:
(volume -& location)
13 . Certification: I hereby certify that the informa 'ond contained herein
G is true and accurate to the best of my knowl
DAVE: LL APPLICANT's SIGNATURE y
NOTE: lssumnoe of a zoning permit does not relieve an ant's burden to oom t
9 P PIY wi M •+P►
zoning requirements and obtain all required permits In e Board of Health. Conservatic
Commission. Department of Publio Works; and other npplloable permit granting authorities.
FILE ,#
JUL Q
�.�
DEPT OFSIiF ` MSPECT�I,)td5 File 1Wo.
NQRTN
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: J�A
Address: Z JjCLA -,-, + -� .Telephone: 4- &-3;rz
— J
2. Owner of Property:
Address: f`�w-� �� /�k/� Telephone: 5 —
3. Status of Applicant: Owner ✓ Contract Purchaser Lessee
Other(explain):
4. .lob Location: S+A-'Le-
Parcel Id: Zoning Map# Parcel# District(s):
(TO 8E FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property �/l
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
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 �dance/Finding ever been issued for/on the site?
NO DON'T KNOW YES IF YES,date issued:
IF YES: Was the pe it 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 41 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-1999-0048
...................................
Building, Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
replacement windows RI C-1.999-000059
.........................................................................................
Paid By: - -------------------•---------------•
Pa.i'�*i'n F
' 'u`1T "0'n:--------
Jeffrey Cranston TueJul 14,1998
.........................................................................................
.. . ...... ......
Received By- C.h.eck.No:.............•••.•.
Linda Lapointe 1058
........................................................................................
................•...•.•••.............
DEPARTMENT'S COPY Amount: $20.00
......................
I)EPARTMENTFILE COPY 29 PLYMOUTH AVE
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:
14 Jul, 1998 BP-1999-0048 $20.00
GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size:
1808 17C 177 001 29 PLYMOUTH AVE URB 4791.6
Contractor: License Type: Insurance:
Jeffrey Cranston HIC
Address: License No.: Insurance No.:
P 0 Box 307 101176
City: State: Zip Code: Phone:
WILLIAMSBURG MA 01096 (413)268-3504
Pro iiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0061 windows replaced $1,200.00
Description of Work:
INSTALL REPLACEMENT WINDOWS
GeoTMSOD 1997 Des Lauriers&Associates,Inc. Signature: