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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. S 2`/-G 1'2 0 Alterations
NORTHAMPTON, MASS. 19_?r Additions
APPLICATION FOR PERMIT TO ALTER Repair
®/d6o Garage
1. Location p 2 F IV oRT"0 Tvh-Lot No.
2. Owner's name -S(f or,- 'OIL-1-5 Address YC� W 1!!2f 8
3. Builder's name�.� S'� �Plfit ) &Oe) /A--(, GA-,K, Address t�-�A16& i 7-1k)"
Mass.Conswcbon Supervisor's License No. .36 6 Expiration Date S/?
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 `'!9✓ILT
13. Siding house
14. Estimated cost:-
�l The undersigned certifies that the above statements are we to the best of his, her
(! knowledge and belief.
Signature f responsible app icant
Remarks � L �O—t` 0t/F& "Ag
.�'0 4� T 1 3
s 1 i Crit� of 11z]
8 d
�xsartchnsrtts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMTENSA`zTON INSURANCE i ' AVIT
(licetiserJpermittee)
with a principal place of business/residence at:
2 (.32/61 _5 ) SI ► 19%�J (phone#) 5-27-01 2e
(street/city/stat&2a0
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 contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Compauy/Policy Numbcr) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compaoy/Po1icy Number) (Expiration Date)
(Name of Contractor) (1-nsurance Company/Policy Number) (Expiration Date)
(attach additional shoo ifnootnary to include infonnation pctrtining to all coatr d rs)
4N41'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 homeowvm who cx ley patens to do m*incnAnc,,o=aricuoa or repair work on a dwelling of
not mono than throo traits in which the homoowner resider or on the grounds appurtenard thereto are not generally ooasidercd to be
employ=undo the workees compcas4cn Act(GL152,s 1(5)),application try a homcow=for a license or prrmit may evideme the
legal status of an employee under tho Workoe'a Compeme-ion Act
I undmt=d that a copy of this statement may be forwarded to the Dep,_, a2 of 7,A, ial Aa6dec&Of$oe of lnsucance for the
coverxgo vrrificatioo and that failure to secure covcrago under section 25A of MGL 152 can lead to tho inVOS Lion of-mmal penalties
ooasL%Cmg of a fine of up to S 1,500.00 and/or imptisoamasi of up to one yew and civil penalties in the form of a Stop Work order and a
fine of 5100.00 a day against—
For di —Only
Permit Number
Mag# 1 of#
Sim of Li ermittce
10. Do any signs ebst 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 —1U= to be filled i.n
by the Building 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
&pai,ed parkingi
# of -Parking spaces
f 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 knowledge.
DATE. / APPLICANT's SIGNATUREIJ7�67-"_ -'Z
NOTE: Issuano of a zoning permit does not relieve an appil4,n ,1,, rden to oomply wit4 all
zoning requirements and obtain all required permits from the EfOAftrd of Health, Conservestion
iCommission, Department of Publio Works and other applioable permit granting authorities.
FILE #
d
Fi 1 e No. P'q�
ZONING PERMIT APPLICATION (§10 . 2
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: /-lnVS
Address: ��_ ST _Telephone: -�-2- 7—0/ 7
2. Owner of Property:
Address: y0 1 44,h;7-/Q0'v- 0y Telephone: S-YU
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): AC)&) ,-1—
4. Job Location:
may'
Parcel Id: Zoning Map# � Parcel# 36 District(s): J/\
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
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 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)
Department: Reference No: BP-1999-0195
...................................
Building,Electrical & Mechanical Permits
Fee Type: Receipt No:
Roofing REC-1999-000388
.........................................................................................
......................................
Paid By: Paid in Full On:
DE Sheppard Roofing Mon Aug 17,1998
.........................................................................................
......................................
Received By: Check No:
Linda Lapointe 1181
.........................................................................................
......................................
DEPARTMENT'S COPY Amount: $20.00
...........................
DEPARTM I EN1' FlLE COPY 40 WINTERBERRY LANE
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:
17 Aug, 1998 BP-1999-0195 $20.00
GIS 9: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
7308 36 230 001 40 WINTERBERRY LAN SR 117612
Contractor: License Type: Insurance:
DE Sheppard Roofing CSL
Address: License No.: Insurance No.:
17 1/2 Briggs 066306
Liin State: Zip Code: Phone:
EASTHAMPTON MA (413) 529-0170
Pro*ect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0330 roofing $3,460.00
Description of Work:
ROOF OVER EXISTING I LAYER
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: