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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER a
Repair
^, ,, Garage
(�
1. Location �+{ I� ` i Nf 4��rn �U y l Lot No.
� Qe-c- Address�-�' ''`� � y � �,� I�. S �—
2. Owner's name �i i
Scj
3. Builder's name C! C- �( —��..Address
) - /'
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
S. 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
<-' Uu
, a -(
13. Siding house i
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief. A w �J Q
Signature o responsible appicant
Remarks
4-St1AhlP�, ,r
JUN 21998 Cr�i�r laf �nx#!#ttnt�#on 4
B � _ �astacgnsrtts
DEPARTMENT OF BUILDWG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKEWS COMPENSATION INSURANCE AFFIDAVIT
e n c !� • c: ��K . r eS►CSP G
with a principal place of business/residence at:
-� phlone )�S"S y 7/
(street/ci ty/AaWZ:i P)
do hereby certify, under the pains and penalties of pegJury, that:
(1/�Iam an employer providing the following worker's compensation coverage for my
employees working on this job:
---rh�—�r ���j e✓S ckt(o Y 5 3 Sa U-8 5-3 f `q
(Insurance Company) (Policy Number) (Expiration 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) (Insurance Company/Policy Numbcr) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional shod ifneocaary to include information pertaining to all omtmetors)
( ) 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 aware that while homeowners who employ parsons to do mai dcnaace.cons7vuioa or repair work on a dwelling of
W man thea throe traits is which the homeowner rc=des or oa tla grounrla appurtenant tberdo are cot generally oomitkmd to be
employ=undcr the worker's oompeasatioa Ad(GL152,ss 1(5))�application try it homeowner for a Uceax or permit may cvidcnoe the
legal statue of an employee under the Workoes Compensation.Ace.
I understand that a oopy of this aLL=ncct may be forwarded to the Depwtmwa of Industri d Aocidm&OfSoo of Inaruanoe for the
coverage verification and that failure to&onus ooverago under soWoa 25A of MGL 152 can lead to the imposition of aiminsl Penalties
oomisting of a fine of up to S1,500.00 and/or imprisonment of up to one year and civil p=zWa in the form of a Stop Work Order and a
find of 5100.00 a day against me.
Signed this day of- h 199 7 For degartmmtnl use only
Permit Number
Map# _Lot#
Signature of Li cryC t
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 column to be filled in
by the Building 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
&paged parking)
# of -Parking spaces
f fof Loading Docks
Fill:
volume--& location)
13 . Certification: I hereby certify that the information conta ' ed ren
_z
is true and accurate to the best of my knowledge.
DAVE: (d APPLICANT'S SIGNATU YI
NOTE: lasuanoe of as zoningpermit does not relieve a w
P pplioant's burd to 0o with,,tall
zoning requirements and obtain all required';permits lrom tiles Board of ealth, Conservation
Commission, Department of Publio Works and other appiioabla permit granting authorities.
FILE #
U t i ,ii, f
JUN 2098
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: - C)q �'i7 1 Telephone:
2. Owner of Property: 01 - Y C, �) � .G
Address: cU g �c��
-j- n()�10 Telephone: 7 V
3. Status of Applicant: Owner Contract Purchaser Lessee
bz—Other(explain):Cc�Y�k oc -k}}�
4. Job Location: C� i tE� `1�• 1 1 o
Parcel Id: Zoning Map# JA Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Prope rty �
6. Description of Proposed U /WorV/Project/Occupa on: (Use additi nal sheets if necessary):
CC'-E rv,e n c1
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 PermitNariance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO L", 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)
w, FILE #
APPLICANT/CONTACT PERSON:
'ADDRESS/PHONE: f
PROPERTY LOCATION:
MAP PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERNIIT APPLICATION_CHECKLIST
ENCLOSED REQUIRED DATE
Fee P id
Building Permit 0115d Alit
Remodeling Tnterinr 14
ArrPccnry Stritrtnre
Owner/Orrupant -Statement
+--^'
T OLLO`VING ACTION HAS BEEN TAKEN ON THIS AP KATION:
Approved as presented based 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
SiEptic Approval-Bd of Health Well Water Potability-Bd Health
Permit from Conservati olnmissia
Signature of Building Ir4for ate
NOTE:lasuanoe of es zoning permit does not relieve an appiioant's burden to oompiy with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authoritles.
' Reference No: BP-1998-0034
Department: ...................................
Building, Electrical & Mechanical Permits
..- -------------------------------------------------------------------------------------
Fee Type: Receipt No:
Vinyl siding & replacement windows REC-1998-000037
.........................................................................................
......................................
Paid By: Paid in Full On:
Larry Jubb Tue Jun 02,1998
.........................................................................................
Received By: Check No:
Linda Lapointe 2827
.........................................................................................
......................................
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: C Inspector: Tracking No.: Fee:
02 Jun, 1998 BP-1998-00341 Stanley Szewczyk 963613 $20.00
GIS#: Map Block: Lot: Address: Zoning Use Group: Lot Size:
7508 184 EARLE ST URB 13590.72
Contractor: License Type: Insurance:
Larry Jubb
Address: License No.: Insurance No.:
P O Box 429
City: State: Zip Code: Phone:
GREENFIELD MA 01302
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1998-0035 $16,500.00
Description of Work:
install siding& replacement windows
GeoTMSQ 1997 Des Lauders&Associates.Inc. C;anwt..rn•