23D-154 (9) Department: Reference No: BP-1999-0204
Building, Electrical & Mechanical Permits
Fee Type: Receipt No:
Non structural interior renovations REC-1999-000401
Paid By: Paid in Full On:
:Anthony D'Agostino Tue Aug 18,1998
Received By: Check No:
Linda Lapointe 1841
DEPARTMENT'S COPY Amount: $40.00
DEPARTMENT FILE COPY 130 HINCKLEY 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:
BP-1999-0204 $40.00
GIS #: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
3310 23D 154 001 130 HINCKLEY ST URB 44431.2
Contractor: License Type: Insurance:
Anthony D'Agostino CSL
Address: License No.: Insurance No.:
9 Fort Hill 053713
City: State: Zip Code: Phone:
HAYDENVILLE MA 01039 (413) 268-3117
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0071 Non structural interior renovati $3,000.00
Description of Work:
ADD DOOR,WINDOW &REMOVE CLOSET
GeoTMS®1997 Des Lauriers&Associates,Inc. Signature:
File#BP-1999-0204
APPLICANT/CONTACT PERSON Anthony D'Agostino
ADDRESS/PHONE 9 Fort Hill Haydenville 268-3117
PROPERTY LOCATION 130 HINCKLEY ST
MAP 23D PARCEL 154 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ✓
Fee Paid /'d^g/ $ D-
Type of Construction:
New Construction ,4c/4 1 (�t(//LG1OZU—
Non Structural interior renovations
Addition to Existing 4,,t ivy _
Accessory Structure
Building Plans Included:
Owner/Occupant Statement or License#
3 sets of Plans/Plot Plan
THE LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
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
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Co on
415
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
U ; 'a
I File No. 9Q)o(f
' DEP1 OF 'x
L- -� --------LZOTING PERMIT APPLICATION (§Z 0 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION/-7'
1. Name of Applicant: ti is h o Pty ,p '/ o S)--/ 4 v
Addre '' !! / ,r I 'ii—r` ( — /
ss.9 /���� �T / ( t, 17 �/C!-Q Lt U I Telephone. �1" 3 � U R - ,3 I j 7
2. Owner of Property: Toy C-e_ S / 61-P 1--
Address:36 1--) 114 c h l / Telephone:
3. Status of Applicant: Owner V Contract Purchaser Lessee
Other(explain):
4. Job Location: / 3 0 Ii/ N C IT I t OM • -
Parcel Id: Zoning Map# J ✓ arcel# Dgri t(s): CL1)!
(TO BE F LLE IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property gc ill -e
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
AcIc1 14) ( U dot° Ac d d.J ,'O 1—,
R-e Gvlo v -C CIO S-2 f-
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)
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
&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 knowled e.
DATE: / 7 7 APPLICANT's SIGNATUREz)
NOTE: Issuano of a zoning permit does not relieve an applio urden comply with it
zoning requirements and obtain all required permits from th oard of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE I
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DEPT OF BUILDI INSPECTIONS 14-e S_e, �`
NORTHAMPTON,MA O16S0
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1 DEPARTMENT OF BUILDING INSPECTIONS ,
�W� DEPT�F 8 __``=
ND 212 Main Street • Municipal Building
��Northampton, Mass. r'v 01060 '
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, y k1 DMAostitlo
(j)dcensec/permitteP)
with a principal place of business/residence at: • ri A, 0 103
CA
H t� �,2 11 hone#) `I/3 z6�' — 3/ / 7
`� ��` 'f �-� � � � � Gel/ �-e (P
,(srstret/city/statelap).)
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 a sole proprietor, general cont..'actor 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) . (Expiration Date)
(Name of Contractor) (Insurance Company/PoLicr Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheet ifnrr-,-te.ryto include information p .ining to all contractors)
(?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 whilo homeowners who employ persons to do mairrlmscir, construction or repair work.on a dwelling of
not more than three units in which the homeowner resides or on the grounds appurtenant thereto arc not geocrnlly oo¢sidcrcd to be
cmployrrs undo the workcea cr -rsation Act(GL152,ss 1(5)),application by a homeowner for a license or permit may evidence the
legal status of an employer under the Workcoh Con Act
I understand that a copy of this ctatcmct may be forwartLad to the Dcpertmcoa of Industrial Aecidmtes'OfEco of Ieouca000 for the
coverage verification and that failure to soeure coy entgo under section 25A of MOL 152 can lend to the'imposition of criminal penalties
comistiag of a fine of up to S 1,500.00 and/or impraormerd of tip to one year and civil penalties in the form of a Stop Work Order and a
fuse of 5100.00 a day against roc.
( -g b For&part l us*only
Permit Number -
::. ,,4,i7
Signature e
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
=r NORTHAMPTON, MASS. 19 Additions
t APPLICATION FOR PERMIT TO ALTER Repair
-. Garage
1. Location 3 0 T 1 L l� C / Iy , I Lot No.
2. Owner's name Jl y e-Q S 11 d-e /- Address E 0 +4 (k c il+ r yn�y
3. Builder's name h ! t� /7 n 5 + 4 9 Address 9 fin 6l 1-1 11 [ a d.eh v l' 1 I-e M A
/ �� r f 9
Mass.Construction Supervirlw's License N"o. CS C, S3 7/,3 Expiration Date 7l f,3
l
4. Addition Add / ^^ 1
5. Alteration e.cMpu� K1 fC iel aIos-e- — Adds lvlti w Ldov rl
kim - aci slid h ''I .
6. New Porch J 1i �
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 3 a O
The undersigned certifies that the above statements are true to the best of his, her
know edge belief. 0 ,.. ..0...
Signasur of responsible appiicanI
Remarks