17D-066 (3) . . ...
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. -n' 19 'IT Additions
APPLICATION FOR PERMIT TO ALTER Repair
AA Garage
1. Location `3 q Co( t r'k U\ L Z. R Lot No.
2. Owner's name tj 4-,X Address R Qr- CIAP-\r��t c 4)t.
3. Builder's name 1�j p 4 w s- D u A\A n-rho Address 1-n C rsrs,, k 3l, Fa' S4 n j,—
Mass.Construction Supervisor's License No. 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—ey,a r
P/ The undersigned certifies that the above statements are we to the best of his.
vS �- P iz r 4 ' knowledge andbMi
Signature of responsible app,icant
Remarks _ 't �
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DEPARTMENT OF BUILDrw INSPEcTIONs
212 Main Street ' Municipal Building '
Northampton, Mass. • 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, ��N� A �I��►A���
(Iiceuscdpermiuee)
with a principal place of business/residence at:
/ �1,C4� S� 2A2� .ic� ���. (phone#)
(strccVcity/slats hip)
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 Date)
I am sole propriet eneral contractor or homeowner(circle one) and have hired
the contractors ow who have the following worker's compensation policies:
(Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Comparzy/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additioml shed ifneccuuy to inclode kdbrmstioe paRa.iniag to all ooab-adore)
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 avrare that while bomco%-D=who employ persons to do oombn ion'or repaY worst on a dwelling of
not mare than throe units is which the bomoowncr rides or oa the grounds g7=UnwA tbetcto arc not generally ooa Wand to be
employers under tbo worka"s comQmutioa Ad(GL152,ss 1(5)).application by a hoa=wnw for a 60=0 a permit may cvidcnoe the
leo%tutus*fan employer under the W«kces C.ompaosation AcL
I undtastaad that a copy of this etstemaa may be fo wwdad to the Dtpwtarat of Iodustrid Aoddm&Me*of Imar*one for tb.
coverage verification cad that failure to wort covalLp under smdoa 25A of MOL 152 tier kid to the imposition of Criminal penalties
comistata of a fine-0f up to SP00.00 mdlor imp r6ottmerd of up to one yew and civil penalties in the farce of a Stop Work Order and a
fine of$100.00 a day agaiail tna
. . ' Fardcpattnoadalweoaly .
permit Numba
signature OrUC6 Wxtittx
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 NO
IF YES,describe size,type and location:
11 ALL INFORMATION MUST BE COMPLETZD, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This Col— to be filled in
by the Buildimg Department
Required
Existing Proposed By Zoning
Lot size
i
Frontage
Setbacks
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved 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 knowled
DME: q -So APPLICANT's SIGNATURE
NOTE: Issuance of is zoning permit does not jreneve an applicant's burden to oomply witty .ill
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 #
i
AU, ' 3 0 fir
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: WjA�Iti-, A DUC-VnA(LM 'C—
Add ress: J V\ 18 S' fi,�—ra�—.j Telephone: �Aa'-H ` Q
2. Owner of Property: lid-i i j )--0vr\6 P,
Address: Z-S (2 f�i l �, g��� Telephone:
3. Status of Applicant: Owner _Contract Purchaser Lessee
Other(explain):(� /�
4. Job Location: 3 3t2\i s �, A
Parcel Id: Zoning Map#V Parcel# (0 tP District(s): (J�4,&-
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property S:riw g. J�Arn `rS
6. Description of Proposed UseA'Vork/Project/Occupation: (Use additional sheets if necessary):
C, 7� ��= l Ac
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)
" . 1
38 GARFIELD AVE BP-2000-0208
GIs#: COMMONWEALTH OF MASSACHUSETTS
MV.-Block: 17D-066 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:roofing BUILDING PERMIT
Permit# BP-2000-0208
Project# JS-2000-0338
Est.Cost: $4200.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Wayne Ducharme 118101
Lot Size(sa.ft.): 7797.24 Owner., LOMBARDI BRYAN
Zoning:URB Applicant: Wayne Ducharme
A_ T. 3.8 GARFIELD AVE
Applicant Address: Phone: Insurance:
15 Gaua St (413) 527-8940
EASTHAMPTON 01027 ISSUED ON.8/3o/1999 o:oo:oo
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE HOUSE & PORCH ROOF
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Final: Final:
Rough Frame:
Gas Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 8/30/1999 0:00:00 $25.00 +
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo