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17D-034 (7) � � m .. p et o cn O fo Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No 3-27-0/ 26) Alterations NORTHAMPTON, MASS. ZZZ 2 Z 19 5— Additions ' APPLICATION FOR PERMIT TO ALTER Repair Garage 1. Location 7 0 `3 �_ S'-7/2 �- /tyr 6_4 Lot No. 2. Owners name P17/1 L M(--- CA;7-&L5,1L Address i9 3. Builder'sname _ )E/zG Address 6elGCS s/, Mass.Construction Supervisor's License No. 666' 3 U t2 Expiration Date /9 Z 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 T f 6 r i &:-/'L-G e_ 'S 13. Siding house 14. Estimated cost-- T ) The undersigned certifies that the above statements are we to the best of his, her knowledge and belief. G Signature of resp sible appicant Remarks •0 l Q „T a Tff� laf faz#I� nT rfnn s AUG 1 7 M �asaschnsrtta EP�T OF BU DEPARTMENT OF BUILDING INSPECTIONS _... 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE ' AVIT (Ii censerJpermi flee} with a principal place of business/residence at: (P66 s-7 ilwf - ©l'd 27 (phone#) (stztx:t/city/stalrlap) 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: (Insurance Company) (Policy Number) (Expiration Dale) ( ) 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/Policy Number) (__E", mdo-?Date) (Name of Contractor) (Insurance Company/Policy Number) (Expim6on Date) (Name of Contractor) (Insurance Compaay/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (auac h additioaal sfwet ifn6ccsiry to inc iafocrosr pctaining to all c'r traders) T 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 homwwvcrs who cmplay pa-sow to do main�constr c on or repair work on a dwelling of not more than throe units in which the homoowncr resides oc on the gruanls appurtenant ibwdo are not eco rally ooasidatd to be employers under the warica's oampcns4on Ad(GL152,ss 1(5)),application by a homeowner for a Uccasc or permit maY evidence the legal datua of an employer under the Workeet Compemation Aot I wsdetatand that a oopy of this ctat emmi may bo forwarded to the Dtpnrtmcn2 of Inrf mUial ArXi3eO&OfEoo of Iuwranoe for the coverage verification and that failure to seatre oovecngo under section'25A of MGL 152 can lead to the inioa of criminal penalties comitting of a'fine of up to 11,500.00 and/or irapriso� of up to one year and civil pcnLWes in the form of a Stop W ork Order and a find of S 100.00 a day against nx- For&p=tmwW uao only Pcrmit Number WO # .: Signature of Li ermittec 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 cclamm to be filled in by the Banding 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 &p=ied parking) # of Parking spaces f of Loading Docks Fill: {vol-ume-& 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: Issumnoe of a zoning permit does not relieve an applioanr burden to oomply wit4'all zoning requirements and obtain all required'; permits from the Board of Health, Conservation )Commission, Department of Publio Works arid other appiloable permit granting authorities. FILE # � AUG 1 7 1998 File No' 7 n. :� ��� �� � � ������ ��� ���������" « �r�� ~ �� PLEASE TYPE OR PR1WT ALL 12gFORMAZXON 1. Name of Applicant: Address: |ephwne 2. Owner of Property: 3. Status mfApplicant: Owner Contract Purchaser Lessee � r Other(explain): 4. Job Location: 36 Parcel Id: Zoning YNap District(s): (TO8E FILLED |NBY THE BUILDING DEPARTMENT) 6. Existing Use ofGtructure/P rope dy G. Description of Proposed Uso/Work/ProjocblJunupaUon: (Use additional sheets ifnaoaosary): 7. Attached Plans: Sketch Plan Site Plan En0inmonad/Gun/eyedP|anu Answers tv the following z questions may ueobtained by checking with the Building Dept p,Planning Department Files. 8. Has a Special PornniUVohnnue/Finding ever been issued for/on the site? NO DON'T KNOW YES IF YES,date issued: IFYES: Was the permit recorded at the Registry ofDeeds? NO DON'T KNOW YE IF YES: enter Book Pagm end/or Document S. Does the site contain a brook, body of water orwetlands? NO DON'T KNOW YE IF YES,has a permit been or need to be obtained from the Conservation Commission? Needs bzbe obtained Obtained— .date issued: (FORM CONTINUES ON OTHER SIDE) Department: Reference No: BP-1999-0194 ................................... Building, Electrical & Mechanical Permits •.•••.....•.•.•.......... Fee Receipt No: Roofing REC-1999-000387 ......................................................................................... ..... ................................ Paid By: Paid in Full On: DE Sheppard Roofing Mon Aug!, 17,1998 ......................................................................................... ...................................... Received By: Check No: .Linda Lapointe 11.81 ......................................................................................... ............................•.•....... DEPARTMENT'S COPY Amount: $40.00 ........................... 1)1!"PARTMEN"I' FILE COPY 30 STRAW 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: 17 Aug, 1998 BP-1999-0194 $40.00 GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size: 1985 17D 034 001 30 STRAW AVE URB 5096.52 Contractor: License Type: Insurance: DE Sheppard Roofing CSL Address: License No.: Insurance No.: 17 1/2 Briggs 066306 L!!32 State: Zip Code: Phone: EASTHAMPTON MA (413) 529-0170 Proiect No: Category of Work: Const. Class: Cost Estimate: JS-1999-0329 roofing $4,460.00 Description of Work: STRIP,PLY& SHINGLE ROOF GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: