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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.�"U3S�'1-1-943'7 Alterations
NORTHAMPTON, MASS. la!ft7 ZQ 19 9-5E- Additions
.�
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location MA rd. M�avk St. . F—larenoes _ Mf} Lot No.
2. Owner's name ej"Atqj 'ckV Address.../ l�Ti nS.UA
t It 3. Builder's name N&L u0alm&&rJ Address s, r"- . cet 9
Mass.Construction Supervisor's License No. CnP390VAG Expiration Date } _2,&d m
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 'L-I10 u•r-,In-'L-.:kr 1 "E_o G o tWlAm -rLzt. Ard-AC-46 d21 a %A v 1 sti:t n1 Q sr'tcl crf RF_
13. Siding house
14. Estimated cost:- +/�f00•om
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
Signature of responsible app icanl
Remarks
a e 3 p 11998
f zssxchnsctts
w t DEPARTMENT OF BUILDING INSPECTIONS
EPT .
N0R-fr;PAFT0N MA(,1 1-0�^ 212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S CO12PENSATTON MSYTRANCE t t AV I-
I,,
(Li ce�secJpermi tree)
%with a principal place of business/resldence at:
1'77 b)�,t, 16-4b,_ (phoney) t ..
(sti-=—Uci ty/statrJnp)
do hereby certify, under the pains and penalties of pcgtuy, that:
O I am an employer providing the following Nvorker's compensation coverage for my ,
employees working on this job:
(La-TL=ce ConP-any) (Policy Number) (1_xpiration 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:
(LT�Tll° Of con 1cwr) NJurn't,f) (~\ LI'd t1n! D-,tc)
-- (Nainc of CoutIOCior) (1P_S=�ncc COIIID«1`'%I Ot'. i �'lll_l 'f) (F?.DlfailOn D2fz)
(Name of Contractor) GDSU C-- Company/Pohcy Numb--I) (Exp�mboa Date)
(Name of Contncior) Gasu,-,.nce Comma /Pohcy Numbes) (Expiration Date)
(L(L1G�7-`..(ldJt]OQaI S��Ct if OCA�S.V-y VJ tDC1U(�JGICSIIII.I CQ pCi'Z�.�Z11II�`LO 1t1 �: ' :3�
(✓✓)` I am a sole proprietor and have no one word no for me.
( ) I am a home owner performing all the work myself.
NOTE:plc=sc be aware Chat whilo hom ,Amc"wbo amplay personr w do m-x +�construction—r�ir work on r dwctling of
Doi mocn tb:-n thaw unity in wt'i.ch the a oa the gyp,, •^t tbccf.o,Do(Fatly coaridcrcd to be
cmploycrm under tlw wovk s oeu j�on Act(GL152-s 1(5)),aFplicatian by a homcovma for a Gcrnx ec permit mn y cv d—the
legal J:tatlla of an cnployoe under tbo Work oar Compm�.Lioo AeL
I understand thzt�copy of thin rtacmcui my bo forw-rdnd to the Dcpnrtmm of i.&,%linl A.cod—&ofd of Ir>3urwoo for 1b,
eovcm verification and th_t failmc to soa=oovcrngo under soetion 25A of h(0L 152 can t--d to tbo'impasition of crimiaA pcnslties y
ooaiitntg of n-fnc of up to S 1,5oo oo zrNor imp ao�of tip W one yur and cavil penalties in the form of a Stop Work order and a
firm of 5100.00 a day against WV-
For d yaricrSal ti'°°°ly
Permit Number
nuCe
S Qtrn l r[t_ t ; � 6 6 2vfap*f Lo 1:#j' t
_ Signlh?��o' �LiocnscclPcrmittcc •'
10. Do any signs ebst 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 NOS_
IF YES,describe size,type and location:
11. ALL INFORMATION MAST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This ccl� to be filled in
by the Banding 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
&pax,ed parking)
# of -Parking spaces
f of Loading Docks
Fill:
(vol-dme--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DME: c s '3e tggj_ APPLICANT's SIGNATURE_', ,*0,22. cam, g
NOTE: Issuanoe of a zoning permit does not relieve an applloant's burden to oomply Wp4 pu
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 #
OCT 3 0 File No.
4
�p ZON' NG PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: .—Frrs<< of
Address: x,'17 0)0Rb_ yid,U Telephone;(g/ -iW
2. Owner of Property: %kj[e.►G,.vu�r�n�J�'4-✓. Inowra,S�
Address: 16j2r3g� h�� b4& Telephone:
3. Status of Applicant: ✓ Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: �G [�� p� S'f; RArp-���1��flr
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))::
tea! , Cdz3* 2t A/� �t��/i w . J 'fd 4 D
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)
Department: Reference No: BP-1999-0452
...................................
Building, Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Roofing RE C:-1999-001202
... .....................................................................................
......................................
Paid By: Paid in Full On:
W M Brown Fri Oct 30,1998
.........................................................................................
......................................
Received By: Check No:
Linda Lapointe MONEY ORDER
.........................................................................................
......................................
DEPARTMENT'S COPY Amount: $20.00
.................. ........
I)EPARTMENTFILE COPY 16 NORTH MAPLE 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:
30 Oct, 1998 BP-1999-0452 $20.00
GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size:
8861 17C 227 001 16 NORTH MAPLE ST GB 6838.92
Contractor: License Type: Insurance:
W M Brown CSL
Address: License No.: Insurance No.:
177 West St 038426
Liy_i State: Zip Code: Phone:
WEST HATFIELD MA 01088 (413) 247-9937
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0872 roofing $1,400.00
Description of Work:
ROOF OVER I EXISTING LAYER
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: