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29-065 (4)
v AA d V .. -ta -V a Z m M 2 O f o �b a 70 n �t in Z > Z p [t7 ca � ^► �7 I � Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No._� Z�' ���`� Alterations a rNORTHAMPTON, MASS. tjL-ru T t ` 19 Additions APPLICATION FOR PERMIT TO ALTER Repair Garage 1. Location -2-3 (171 L'�Vt� � - Lot No. 2. Owner's name T l - �4 c'� l-S ( Address Z 3 (,Tl LgAa±j :CQA9 a-% 3. Builder's name `J jk QL<=� C-6 EA S" r Address b `Sr �i� R . UJ209 414 Mass.Construction Supervisor's License No. 4�O"7 t `� Expiration Date (do SCE 4. Addition 5. Alteration S_ I LD iP `-V" IAA o LA-r- - 6. New Porch W Zj,� 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:- o The undersigged ce tes at the abo tcmcnts are true to the best of his, her knowledge ief. o/ Signature of responsibl appicant Remarks ne-F' CIkl. (lsr. 1C'Ce.l ©U(Q RAT(1(c7u-0 Lt� 1*n RIM LIN-C� Y 3 Ilk s 0 g N k Po a Llf Na rt[jamp fait _ a 4 AUG 1 4 �`� �:saarhnsclla ` FKT OFfI DEPARTMENT OP DUILDrNG INSPECTIONS PLOP 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORTCER'S CW4PENSA`zION 1NSTJ A_NCE ArTmAV117 (llctin',4nuIttcc) with a principal place; of busincsaJresidence at (stz�rt/city/staleJ�p) do Hereby cc-1 y, ul?der the pains and penaines of pe>7ury t11 , ("�I ani ah employer providi:�; the follov,,111,� worker's for im employees ',�r�?:'_:in�, on t?1iS job: � . ! 9 �i.�:�f�t,� -__�6cn�-ice- �I`� (JasuL:Sir' O f myi a sole proprietor) general contractor or honlica-viler (circle one) 2nd have hired tile contractors listed below who have the following workers compensation policies: (Name of Contractor) (LmsiicaacC Company/Poky Nmnh-i) {Txpirtion Dale) (Nave of Contractor) (Irlamluce Company/Policy Nun1112r) Cl-r:nuation Date) (=ttadl ad3ihccil s::.Y-L if ncccssry to ic��uc.4 i;�-lonnilict.pc':.r�2iis Cn rill cc<v'ra��n) O I am a sole proprietor and have no one worklmy for me. ( ) I am a home o`mer performing all the work myself. NOTE:plc-- be aware that w-i10 hcarown Sa At 3 aarplay perwm to do maiutcntn'c,fit-0 or rzPau worse on s d Sell rig of not morn than ihroo units is which the bcmbOSN'n<x r,=dn or oo the zppsrtcur�the-cto I o,X&,n.=�Y oocnidcrcd to be cmployaa under the woeir,�,00tr�on Act(GI-152,n 1(5)x,npplica im try e hOa]LONaCr far a UC=13-cc permit may cvrdcm- the legil rtzfus of an e nployor under the Woci c'x C.ompmzatioa AcL I un&rz d tfvd a copy of this rt ccncca may bo forw-ard.ed to tho Dopattu3m1 of lndc�al A=te Om o'of Iusuraeoo for the oova-i e vaifieatioo and that failitte to somm cov.-rnbw tz_ndcr scetioa 2 5 A of bi4L 152 can lead to tbd it oo of criminal p-m cl comisrina of a fine of up to SI,500.00 e4d/oc i$pri--Oi a of tip to otx year and civil pcas2lia in the form oC a Stop Work(hdrs and a f=of5100.00 a clay ttpinst tnc For&P-t n 1 use Daly Permit Number Map" X of# Signature f-LiccascclPermittm- 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 —7== to be filled is by the Building Depasemmne Required Existing Proposed By Zoning Lot size tAo Frontage Setbacks - side L• L: �R: - rear Building height Bldg Square footage %Open Space: (Lot area minus bldg &paved parking) # of -Parking spaces f of Loading Docks Fill: {voZ-ume--& location) 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. DATE: APPLICANT's SIGNATURE NOTE: Issuance of a zoning permit does not relieve an applicants burden to oompiy With1 ,ail zoning requirements and obtain all required permits from the Board of Health. Conservation Commission. Department of Publio Works and other applloable permit granting authorities. FILE # � A i9s NORYt >,at „r' vet File No ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: Slk * ' Address:2-t1b b r VA-2f;ffi� Telephone: 2. Owner of Property: �'+'r•J L d' "�� C �! Address: :E , Telephoner 3. Status of Applicant: Owner V”" Contract Purchaser Lessee Other(explain): 4. Job Location: Parcel ld: Zoning Map#�_ Parcel#—Lb-� _ District(s): 4ZA (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/property 51 L 6. Description of Proposed Use/Work/Project/Occupation: Use additional sheets if necessary): �P��I'["i o�►�.Q . � ...�,7�k-c�- r 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) File#BP-1999-0187 APPLICANT/CONTACT PERSON Sackrey Construction ADDRESS/PHONE 288 Chesterfield Rd. (413)527-3465 PROPERTY LOCATION 23 GILRAIN TERR MAP 29 PARCEL 065 ZONE URA 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 _ Type of Construction: New Construction Non Structural interior renovations Addition to Existin¢ Accessory Structure Building Plans Included: Owner/Occupant Statement or License# 3 sets of Plans/Plot Plan THEE 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 ai 'of �a th Well Water Potability Board of Health Permit from Conserva ' Commiss n Signature of Build' 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. -4P Department: Reference No: 3P-1999-0187 ................................... Building, Electrical & Mechanical Permits ......................................................................................... Fee Type: Receipt No: Non structural interior renovations REC-1.999-000380 ......................................................................................... ...................................... Paid By: Paid in Full On: Sackrev Construction Fri Aug 14,1998 ...... .... . .... eceived By Check o": .Linda Lapointe 4704 ......................................................................................... .......•...............•.••........... DEPARTMENT'S COPY Amount: $40.00 ........................... DEPARTMENT FILE COPY 23 GILRMN TERR 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-1999-0187 $40.00 GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size: 4791 29 065 001 23 GILRAIN TERR URA 18513 Contractor: License Type: Insurance: Sackrey Construction CSL Workers Compensation Address: License No.: Insurance No.: 288 Chesterfield Rd. 040714 na City: State: Zip Code: Phone: WESTHAMPTON MA (413) 527-3465 Proiect No: Category of Work: Const. Class: Cost Estimate: JS-1999-0324 alteration-addition $10,000.00 Description of Work: REMODEL BATH &PARTITION GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: a* r ` m �-, .: <. 1q, , ;z � z I ? M �,� .,g - Y ,� t - x 'r.,' �`z. 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