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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No Alterations
NORTHAMPTON, MASS. O 19 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location g Q �M S T Lot No.
2. Owner's name_ �� // `�/ Address `C C S T Flo,`e n c P �q
3. Builder's name W N s7�e�v, q5 j rI•saf Address
Mass.Construction Supervisor's License No. / 5� 3 Q 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 nn / r
12. Type of roof Y� e n n.s l cP 0 e) Or
13. Siding house S J,`n d, --V`!Q ilk tt
14. Estimated cost:- 3
3 '% The undersigned certifies that the above s ments are we to the best of his, her
J knowled d belief.
/ Signature of responsible app,icant
Remarks
i �ttAlt fn`, r
s , + Crib laf 'Wart 11allytell
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--- ..sr,_ DE ARTMENT OF BUILDrNG INSPECTIONS
DEPT OF SUIIDI€wG lei re
PVOTNR17fOk, n, 2 2 Main Street ' Municipal Building
Northampton, Mass. 01060 ,~
WORKER'S COAUENSAZTON INSURANCE 'MAVIT
I r'l e S Z_c.1( 4-,7-0 ---
(li cerLSCr'/permi tier)
with a principal place of business residence at:
(Phoneiz) C274 `51-2 Z
(str�.t/ ty/staie/zsp)
do hereby certify, under the pains and penalties of pcqury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees work-ug on this job:
(Inu=re Company) (Policy Number) (E)cpiration 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) (Lasurance Comna�y/Poticy Number) (Lxpiration Date)
(Name of Coutractor) (Insurance Como anv/Policr Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expimtioa Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additicail sheet ifnoccasry to include informitioa pertaiaing to all corn o s)
(4<1 am a sole proprietor and have no one worl6ng for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that wElo homcowma wbo employ perT to do m .,, „n masuuctioa or repair work on a dwelling of
not mom thm throe units in which the homoowncr r=dc�or on the grounds apVadm at thcrdo arz ool generally cooJidcred to be
employers under the worku's.ec>mpcnzatice Act(GL152,s 1(5))�application by a homcovmcr for a license cc permit may evidence the
legal etatua of an employee under tbo Woriwr'a Compomafio i Ad
I unatrWnd that a copy of thin rtatcmcut may be fbrwnrded to the Dcpartmcoi of Industrial Accident''Offioo Of Irrwraenoo for the
cover g vcrMcatioo and that failure to s==covcrngo undo soctioa 25A of MGL 152 can Ixd to the'iii on of aimb-1 prnaltics
oomist mg of a f oc of up to S 1,500.00 and/or imprizoamcat of tip to one ynr and civil pcUtwes in the form of a Stop W oric orda and a
find o s .00 a day against tae.
ga use Daly
q permit Number
h l l 1&0 Lot#
Signattu�ofLianseelP rmitxce
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.
Thi's col== to be filled in
by the BniIding 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
&paved parking)
# of -Parking spaces
#' 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 knowle .
D�II'E: Q Q$ APPLICANT's SIGNATURE
NOTE: l"suahoA of a zoning permit does not relieve an appiloant's burden to oomply with ,ell
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appiloable permit granting authorities.
FILE #
a U+ V3
off File No. eP09354c
DEPT OF BUILDING INSPECTiJi
NORTHAMPTON,Ma oios� NING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 7`,e/ .rz lX �' Ca0orl �
Address: Telephone: ? 2 7
2. Owner of Property: SCo t a7,0 ,"eve
Address:—L-/ 3 tct�ke, S7- Ffol'e zc t° �A. Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: q '5?. L";' Kc S-
Parcel Id: Zoning Map# 17 G Parcel#_ 2J LI Z 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):
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-1999-0340
...................................
Building,Electrical & Mechanical Permits
..........
Fee �W�: Receipt No:
Roofing REC-1999-000900
Paid.6y: Paid in Full 0 n
Western Mass Siding& Roofing Thu Oct 01,1998
................................................................................... ......................................
Received By: Check No:
Linda Lapointe 2287
.........................................................................................
......................................
DEPARTMENT'S COPY Amount: $20.00
...........................
I)EPARTMENT FILE COPY 48 LAKE 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:
01 Oct, 1998 BP-1999-0340 $20.00
GIS#: Man Block: Lot: Address: Zoning: Use Group: Lot Size:
1898 17C 307 001 48 LAKE ST URB 12806.64
Contractor: License Type: Insurance:
Western Mass Siding&Roofing HIC
Address: License No.: Insurance No.:
63 East Street 105630
Liya State: Zip Code: Phone:
EASTHAMPTON MA 01027 (413) 586-5227
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0710 roofing $8,800.00
Description of Work:
INSTALL VINYL SIDING& SHINGLE ROOF
GeoTIVISO 1997 Des Lauriers&Associates,Inc. Signature: