24A-018 (6) Department: Reference No: BP-1999-0356
Building, Electrical & Mechanical Permits
Fee Type: Receipt No:
Roofing REC-1999-000946
Paid By: Paid in Full On:
George Thibodo Tue Oct 06,1998
Received By: Check No:
Linda Lapointe 1797
DEPARTMENT'S COPY Amount: $24.Q0
DEPARTMENT FILE COPY 119 PROSPECT 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:
06 Oct, 1998 BP-1999-0356 $20.00
GIS #: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
3375 24A 018 001 119 PROSPECT AVE URB 11238.48
Contractor: License Type: Insurance:
George Thibodo HIC Workers Compensation
Address: License No.: Insurance No.:
177 Park Street 107483 Commercial ins
City: State: Zip Code: Phone:
EASTHAMPTON MA
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0560 roofing $4,500.00
Description of Work:
SHINGLE ROOF OVER 1 LAYER
GeoTMS®1997 Des Lauriers&Associates,Inc. Signature:
11.17T
SEP 3 0 ;998
File No.1/'93sc
DEPT OF BUILDING INSPECTIONS
NORTHAI�PTOk M�OtG6Q
ONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR' PRINT ALL INFORMATION
1. Name of Applicant: 7f`�c /__G
Address: / 934 I4 Telephone: co/ a /y,-.?
2. Owner of Property: l/S/34/1I l'D2g0'5
Address: //9 /'bo ere r� 9/ie Telephone: 317- g -I'9$'/
3. Status of Applicant: Owner Contract Purchaser ✓ Lessee
Other(explain):
4. Job Location: /72 P d$�prt f•/�
Parcel Id: Zoning Map# c9 7 /9 Parcel# / t District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)'
5. Existing Use of Structure/Property 'Q;.h e
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
/�a A2007' ntI9/7 ( L,Aj/e
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 1/
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
I 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 knowled9'e.
DATE: /C/30A" APPLICANT's SIGNATURE %= 4: c 11 4
NOTE: Issuano6 of a zoning permit does not relieve an applioats burden to comply with-all
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
FILE #
•
4 Z1AM j V I� •U
"- 1 CI.xig o f Naz#Iiantpfan
6w1�:• ')lute' 1 =
t1,41 1./P SEP 3 0 lam$ 1.� assarllnsetta
'''"7' - - J D•PARTMENT OP BUILDING INSPECTIONS = t r
-���DEPT OF BUILDIr?G±�^t'�; =__=1
• NORTHAM TOt; ,Try;S,t°; =? y^ 12 Maui Street Municipal Building '
Northampton, Mass. 01060 r'
WORKER'S COMPENSATION INSURANCE Ab'1TDAVI'I
Go7 e 7- 4,01fX, .
(llcenseeJpernv ttee)
with a principal place of business/residence at:
- TO (phone#) �o �' ? 99
(stieet/city/ rip)
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:
Cowllhl a►', t. / (4 'o
(Insurance Company) (Policy Number) Ira on Date)
•
(44 am a sole proprietor general contractor or homeowner(circle one) and have hired
the contractors listed below who have the following s compensation ensation policies:
•
•
(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)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheet ifne—r.ry to include information pertaining to all oomractorr)
(i►14 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 w-hilo homeowners who employ persona to do m.i„urn+o,- construction-or repair work on a dwelling of
not mots than three units in which the homeowner sides oc oa the grounds appurtenant thereto are not generally considered to be
employers under the worker's axtrp- Lion Art(GL152,ss1(5)),application by a homeowner for a liccsse oc permit may evidence the
legal sta±ua of an employee under the Worker's Compensation AcL
I understand that a copy of this etat:ment nary bo forwarded to the Depart:mos of Industrial Aceideob'Ofoo of Insucaooe for tla
coverage verification and that failure to secure coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties
consisting of a-fine of up to S1,500,00 and/or imptisoamcnt of up to one year and civil penalties in the form of a Stop Wort Order and a
fins of S100.00 a day against me.
For ci.p.rtirezifit use Doty
Permit Number • -
Map# . Lot# -
_ Sigma of; icenscelPermitiee Date
>
rii
r I
CA Z
� �-c'tlan , a- cn O
o Z ^' m
a
1
Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
24r NORTHAMPTON, MASS. ,j3 19 Additions
" `'; APPLICATION FOR PERMIT TO ALTER Repair
Garage
I. Location //7 1 o t d /71k Lot No.
2. Owner's "YQ
name ,4 AA/A/ &v et S' Address ii? R0- ..rf �Ue
3. Builder's name (F.O, 1 L04 j Address ;7 7 J/K A-bsik,41rjp f0Y1
Mass.Construction Supervisor's License No. f//.e - 4,10 '/A'.3 Expiration Date S�'3 00 /
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 4 C 18611ova (: ) h yU
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and lief. ,
4
Signature of responsible applicant
Remarks A foe ovo (' ) Jv, o t