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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. ✓�` ' Alterations
NORTHAMPTON, MASS. 19 Additions
a /,/"APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location Lot N
2. Owner's name i9 '!> Address 's
3. Builder's name t' It Address = -
Mass.Construction Supervisor's License No. Expiration Da e
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 % s '
13. Siding house
-r?
14. Estimated cost-
The undersigned c s YiA the above star ms are true to the best of his, her
knowledge lief. n
V
r Signawre of responsible app,itanl
Remarks as -
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DEPARTMENT OF BUILDING INSPECTIONS
" "~- •� Rq t�1G60 212 Main Street ' Municipal Building
Northampton, Mass. 01060 '
WORKER'S CO?,gENSATT.ON INSURANCE AF MA.VIT
(licensedpermittcc)
with a principal place of busty' ess/reside at:
— 0a hone
city/stateJap)
do hereby ceF ffy, 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:
Gasi=c:c� Co.ulpany) (Policy Number) (Expiration Dale)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compen-sation policies:
(Name of Contractor) (Insuran(—_ Company/Policy Number) (Expiration Date)
(Name of Contractor) (insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Poiicy Number) (Expiration Date)
Ot]ach additional sbc ifntocnI y to int-}udc iafbr i con pcztaiuing w all o�otrsdn s)
I am a sole proprietor and have no one working for me..
( ) I am a home owner performing all the work myself.
NOTE:plcssc be aware tbxi wbilo homeow-ncca wiry c=ploy pasom to do mxm*�•*+�comtruction'or rcpa it work,on a dwelling of
not mono thin throo units is winch the bomoowna'rcmdes or oo the grounds appurtcasni thaeto arc oa gma-ally considered to be
emptoyas under tho woriva's oomp=eion Ater(GL 152,ss 1(5)�app licaSon by a homcowr�r for a Eotw0 or Pera'a may cvid—the
legs!etahra of an employer under tho Worlcoes Compomaiiou Acs..
I undmund dm4 a copy of tbu catemeat auy be forwarded to tbo Dapartasm2 of TndsuRial Aoeid eahe Offloo of 1=u vnoe for the
oovaago wrMc tioe snd that LWum to a==covcragv under soctioa 2 5 A of MOL 152 can 1c d to the imposition of criwlnA peadd-
ax siiag 04 fine bf up to 11,500.00 andlor of tip to one y=and avta P=,W,=in the form Of Stop Wore Odder sad a '1
fine of s 100.00 a day against ma
Foe depatinental urao oaty
Pcrmi
—r� l
Si � ��
'�fLi sr>zuticc -
• . a
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.
Mi= colvmm to be filled in
by the Banding Department
I 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 parkingi
# f Parking spaces
f %f Loading Docks
Fill:
�(vo1-lime--& location)
13 . Certi/ea t.ion: I hereby certify that the inform `on contai 'd herein
is tnd accurate to the best of my kno edge '
D?II"E: ;;,�;' A PPLICANT's SIGNATURE
NOTE: Isauanoe of a zoning permit does not relieve an ap lioant's burden to oompty wit 4 �pll,.
zoning requirements and obtain all required permits frofn the Board of Health. Coinservtation
Commisaion, Department of Publio Works and other applloable permit granting authorit;oa.
FILE #
\
Fila No
== X== PERMIT == P====TX== (§10 . 2)
PLEASE TYPE 0R.YRINT ALL INFORMATION
1. Name of Applicant:
Add
_ Owner_' ' '-p-''^
-. Status -' Applicant: Owner--_--_- _ -_---'Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# Paroe
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of8bucture/P rope dy
6. Description of Proposed Une8&o/k/Pnojooh\]uuupaUon: (Use additional sheets if necessary):
z 5,X�10 V
7. Attached9|ans: Sketch Plan Site Plan ngineered/Sun/mvedP|ono
Answers oo the following o questions may beobtained by checking with the Building Dept p,Planning nepartrm,ntFiles.
O. Has o Special PernniVVohanoe/Finding ever been issued for/on the site?
NO DON'T KNOW YES [F YES,date issued:
IFYES: Was the permit recorded et the Registry ofDeeds?
NO DON'T KNOW YE
IF YES: enter Book Pege and/or Document
Q' Does the site contain o brook, body of water orwetlands? NO DON'T KNOW YE
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs toba obtained Obtained .date issued:
-
'
(FORM CONTINUES O0 OTHER SIDE)
'
Department- Reference No- BP-1999-0462
..................................
Building, Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Roofing REC-1999-001264
....................................... ............... .................................
Paid By: Paid'i'n'...F...uTI...®n:
Robert Thibodo Thu Nov 05,1998
.........................................................................................
......................................
Received By: Check No:
Linda Lapointe 6462
.........................................................................................
......................................
DEPARTMENT'S COPY Amount: $20.00
---------------------------
1)E PARTM 1'.NT F IL 1, COPY 154 NORTH 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:
05 Nov, 1998 BP-1999-0462 $20.00
GIS Map Block: Lot: Address: Zonin$!: Use Group: Lot Size:
4396 25C 009 001 154 NORTH ST URB 9278.28
Contractor: License Type: Insurance:
Robert Thibodo HIC
Address: License No.: Insurance No.:
P 0 Box 201 104465
City: State: Zip Code: Phone:
NORTHAMPTON MA 01061 (413) 586-0391
Pro*ect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0898 roofing $1,000.00
Description of Work:
RUBBER ROOF & SHINGLE OVER I LAYER
GeoTMS@ 1997 Des Lauriers&Associates, Inc. Signature: