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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. �1 W? 19 Additions
APPLICATION FOR PERMIT TO ALTER a
Repair
Garage--
I.
arage1. Location l c�� r Sr Lot No.
2. Owner's name -✓� ° e "�`� Address l lfy
3. Builder's nameC'�` (�^z�s ✓n Address %�� �'��s S-
Mass.Construction Supervisor's License No. 0�'��G� 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:- N S
The undersigned certifies that the above statements are we to the best of his, her
knowledgei��belie����
Signature of responsible app,icant
Remarks �T�< ��,i/i�f ���� S�-.•�/_� �'� ���� 't ��
91
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m DEPARTMENT OF BUILDNG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSAUON INSURANCE A t ' A.VIT
(li censceJpermi ttee}
with a principal place of business/residence al:
(strc-uci ty/statdzi p)
do hereby certify, under the pains and penalties of perjury, that:
O I am an employer providing the follo%ving worker's compensation coverage for my
employees worming on this job.
(Insurance company) (Policy Number) (Expiration Date)
O I am a sole proprietor, eneral con�ractor�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 Numba) (Expiration Date)
(Name of Contactor) (Insura.ncc, Compan),/PoLicy Number) (Expiratioa Date)
(Name of Contractor) (Lusuranc-- Comparry/Policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(atiath additioml ibect if Doasi,y to iDc}t,tSc infocmiti oa Pertaining W elJ ooatradon)
O I ani a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware th21 Wbilo bomeownera who employ persom m do Dvtir�comvcdoa:cr repair work on x dwelling of
not more than tbroo--dI in which the boAyoowocr rraiacs oc m do grounds appeutcnanl ibacto me Dot gco=lly oo idcrcd to be
employes ander tba workCex oDmpC=atioa Act(GL1pplicz6oa by a homeowner for a licca-a Permit may cvidcz,cc th*.
le9d ctat„i ofasomployecundertis,wockce,com ,iion,ka-
I ttndcsstind.tfvta copy of thu rmtemcat sway be tocwu,ded to tlao Deputmcad ofInrStshie!Ancdcait Ql5oe of fnx,ranee toe.tba
covecxgc va�fieation and that failure to secure,sovango uudcr vection 25A of MGL 152 C2A kad to tbo'imposshon orcri=6 I penalties
oomtstingU-k- hd bf up to'S I,556 00 andloc
oft?to ooc yav'and atin7 pcna2Ua to the form QC A Stop Worfc Ocdtc
^
S111ItC QLIPCILDItGCC . r 5 y * 2�ri ,; ;,
ijc
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 c__
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This coli to be filled in
by the Badding 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)
# .�f Parking Spaces
,# of Loading Docks
Fill:
4 vol-ume--& location)
13 . Certification: I hereby certify', that the information contained herein
is true and accurate to the best of my knowledge.
DATE. A.PPLICANT's SIGNATURE
J" NOTE: Issuanoe of at zoning `
permit does not relieve an app oanYs burden to oompty wit4,.a1l
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission. Department of Pubiio Works and other appiioabla permit granting authorities.
FILE #
f
MAY 2 7 ;998
�=
Fil �(,e No. L I
ZONING PERMIT APPLICATION §10 . 2
PLEASE TYPE OR PRINT ALL INFORMATION
�s
1. Name of Applicant: ��y �>"-_ �
Address: '3'- `��` S� /;/, Telephone:
2. Owner of Property: .� %!�C /YC;ct1612,
Address: l�y f'1 Telephone:
3. Status of Applicant: Owner 1--Contract Purchaser Lessee
Other(explain): c
4. Job Location: /
Parcel Id: Zoning Map#,2-- Parcel# '41District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
S. Existing Use of Structure/Property /76---t c
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 PermitAlariance/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 l/" 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)
7 �
� FILE #
MAY 21 '1998
APPLICANT/CONTACT PERSON:
n DRESS/PRONE• �21
PROPERTY LOCATION: .-e �-
MAP 8,,,�r PARCEL: 6i!�-' ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION_CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FH,T.FD OUT
Fee P-gid
IRTI Wing Permit Filled ont
Fee PAid 42-33-2
Addition to Existing
0667 3
a / �3
T�LLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
Approved as presentedfbased on information presented
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received &Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval-Bd of Health Well Water Potability-Bd Health
Permit from Conservatio ommission
Xz-1-
SignaWe
of Building ector Date
NOTE:issuance of at zoning permit does not relieve an applicant's burden to comply with all
zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
Department: Reference No: BP-1998-0026
..................................
Building,Electrical & Mechanical Permits
.....................•...................................................................
Fee Type: Receipt No:
Roofing REC-1998-000029
......................................................................................... ......................................
Paid By: Paid in Full On:
Roy Omasta Fri May 29,1998
......................................................................................... ......................................
Received By: Check No:
Linda Lapointe 12337
......................................................................................... ......................................
DEPARTMENT'S COPY Amount: $20.00
...........................
DEPARTMENT FILE COPY 184 EARLE 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: `r Inspector: Tracking No.: Fee:
29 May, 1998 BP-1998-0026 Stanley Szewczyk 963586 $20.00
GIS #: Mau Block: Lot: Address: Zonin Use Group: Lot Size:
7508 38 064 001 184 EARLE ST URB 13590.72
Contractor: License Type: Insurance:
Roy Omasta
Address: License No.: Insurance No.:
21 North St
City: State: Zip Code: Phone:
HATFIELD MA 01038 (413) 247-5666
Project No: Category of Work. Const. Class: Cost Estimate:
JS-1998-0027 $450.00
Description of Work:
strip& shingle porch roof
GeoTMS40 1997 Des Lauriers&Associates.Inc. Citm�fi.ra•