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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 191 Q Additions
Repair
APPLICATION FOR PERMIT TO ALTER
___ Garage
1. Location < �j ,rr to Lot No.
2. Owner's name -La r r 4-, Address H,I c' 1A S�+
3. Builder's name �� �� ��FSL�Q Address SA S+
Mass.Construction Supervisor's License No. �U Expiration Date A I o q 1,;C000
4. Addition
5. Alteration Al < ti s,
6. New Porch
7. Is existing building to be demolished?
S. 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- (��D
The undersigned certifies tha the above stategtcnts are we to the best of his, her
knowledge and belief.
,
gnat IW4 of responsible app icanl
i
Remarks
04�tUVlP�. t,
a ' .} �a3E AClj IiSrllS -
e tf
8 1998 �.
DEPARTMENT OF BUILDING INSPECTIONS
DEPTOF$UI .7 •; 212 Main Street r Municipal Building
110MAM?TON MA 01'66? ,) Northampton, Mass. 01060
WORICER� CO ENSATION INSURANCE Arl IAVIT
f
(licen_SerJpermittee)
with a principal pl of business/residence at-.
L�.
11,3 QC4 01 o6Q (phone#)
(stre_-Ucity/state/zip)
do hereby certify, under the pains and penalties of pequry, 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)
O 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) (Insuranc Companyipcticr Number) (Expiration Date)
(Name of Contractor) (Insurance Company/''i olic-;Number) (Expiration Date)
(Name of Contractor) (Insurance. Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(mach additional sheet ifnoD= try w mchsdc i-1"muIIoo pacaimng to au ccatmo r')
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 bomcowaaa who cc lay pccsow to do maint�coastructioa or rcparr work on a dwctling of
not more than three units is which the homoowacr residn or on the voua6 appurtcaiut thereto arc not gcoer,,dy 000sidcrcd to be
cmployrta under the worker's oompsts4on Ad(GL152,ss 1(5)),application by a homcowna for a liccasc or permit may cvidcocc the
legal o-w of as employer under the Workeez Compmzatiou Act
I undasrand that a copy of this stsf—m t may be forw^tided to the Depar�of Industrial Accidents Offioo of I=XU-*z a for the
eovcrage verification and that fail=to srxttre 00N c bo under scetioa 25A of MGL 152 can Icad to the ia>poSition of criminal penalties
ooaust mg of a fine of up to S 1,500.00 aadlor of tip to one year and civil pealhia is the form of a Stop Work Order and a
fmo of Slo0.00 a day tpinA me.
For d1 use only
Permit Number
Nfap4 Lot#
Si Licensc eiTermittcc
w ,
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 DENIED DUE TO
LACK OF INFORMATION.
This col== to be filled in
by the Bailding Department
Required I
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
&pax,ed parking)
# of "Parking Spaces
f 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 SIGNATURE
NOTE: Issunnoe of at zoning permit does not relieve an appiloant's burden to oomply With-all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applionble permit granting authorities.
FILE #
1998
File No
"J/O--
DE N rota w'j'v`` ONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: I/A i'�A C 1
Address: 3 l ( I C, L�---- . Telephone: 6
2. Owner of Property: AE.O
Address: C Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): c
4. Job Location:
Parcel Id: Zoning Map# / 7d, Parcel# lam District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property I
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 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� 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)
0. Reference No: BP-1999-0199
Department: ...................................
Building,Electrical &Mechanical Permits
Fee Receipt No:
Roofing REC-1999-000396
Paid By: Paid i n Full 0 n
Kim Rescia Tue Aug 18,1998
......................................................................................... ......................................
Received By: Check No:
.Linda Lapointe 4369
......................................................................................... ....................•.................
DEPARTMENT'S COPY Amount: $20.00
........... ...............
DEPAR'T'MENT FILE. COPY 48 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: Tracking No.: Fee:
18 Aug, 1998 BP-1999-0199 $20.00
GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size:
1797 17C 166 001 48 HIGH ST URB 11804.76
Contractor: License Type: Insurance:
Kim Rescia CSL
Address: License No.: Insurance No.:
311 Locust St 022464
Li!l; State: Zip Code: Phone:
FLORENCE MA 01062 (413) 584-5816
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0337 roofing $2,000.00
Description of Work:
ROOF OVER EXISTING I LAYER
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: