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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. °'/ <2 19 � Additions
APPLICATION FOR PERMIT TO ALTER Repair
a
Garage
1. Location 4/t M/9 P4,<-- 5�� i / !-U rl Lot No.
2. Owner's name Address 1y/
3. Builder's name 1--'9/2-�`9 T ys5'.•v7-YGh Address �l< l��T �v S r G.r,��S
Mass.Construction Supervisor's License No. 455 L/ 6la Expiration Date 5//2- t)
4. Addition
5. Alteration
6. New Porch
7. Is existing building to be demolished?
S. Repair after the fire
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof �}} �i�lf�Yt T S �ww ✓5
13. Siding house
14. Estimated cost:- 70 Ov
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Si at a of responsible app.icant
Remarks /woe U vr£gi' <�/�G� y�2 D/= /�S✓'!f/Na v`!>`irt� G
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m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSAaTON INSURANCE AY ' AVIT
41-7 n �t> s
with a principal place of business/residence at:
11V4 A/ si 2� � !�'�'JS (Phone#) - yes
. (me~t�city���p)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the follo`ving worker's compensation coverage for my
employees worL-ing on this job:
(Insurance Compaay) (Policy Number) (E.xpiradon 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 compensation policies:
(Name of Contractor) (Insui-aac: ConTpany/Policy Number) (Expiration Date)
(Name of C011tr,lctor) (Lasurancc Compauy/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/pobcy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(atla.ch additioml:huc.i if ncocaary to incllidc infixmatioo pczYniuing to all o�atractors)
YN
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 awirc that%�h o homcrnwcn wb,,cmpt ay pa son to do mxbjicjxacr,coas ry 00:ar repair work on a dvvclling of
not mo"than thtuo units in which the h0000wvcr r=&3 or oa tho grounds appcsrtcnant thereto arc oct ly 000sidcscd to be
cmployaa under tba worker's comp,=,s c,,Act(GL1 52,n l(5))�ap dmfion by a homoownir for a liomsc a permit may cvid.cnoc the
legal etntus of an omployec under tiro Workela CompemLboo rLct
I understand that a Dopy of tlsu critcmcnt may bo forwarded to tho of Inrfisslri el Amy QISof of Imur.00u for the
coverage vccificzaoo and that failure to somm oovcragu under sodioo 23A of MGL 152 c2A lad to the impos °°of"min4 pm'Wcs
ooaii�ing of x fiw bf up to SI,00.00 andlor imptisovmcai of up to one year and civil pcoiWcs in the tone oCa Stop WoilcOcder and a
5no 0(5100.00 a dry.&mast Me.
For dcQatmmt d uio only
/1 PCfIDlt Number
—
Sigoatinrc ofL crmittcc --
10 Do any signs exist on the property? YES NO I,
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 cols to be filled in
by the Building Department
Required I
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 knowledge.
_1
DATE: S �2 G��j APPLICANT's SZ'GNATURE -u-
NOTE: Iasuan a of a zoning permit does not relieve an ap'lioa den to oomply With all
zoning requlraments and obtain all required permits from the Board of Health. Conservation
Commisaton. Department of Publio Works and other applioable permit granting authorities.
FILE #
' MAY _
4 2 2 Ism //
Fi l e No. 96- (f�
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: Zo nizy -7
Address: Telephone: /V 75 7
2. Owner of Property:
Address: /U/ AA Sj7 FZU-A* "64elephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: f'"/ /t-! n1/�PG�' Sr_—
Parcel Id: Zoning Map#-.-- Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property TGUy
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
�///d✓�/� D//�'n.i t�'.X.e$77iv� ��P�' Lirra� �G'%�.�-ZT �"rfl.✓Ic�LO�'S
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.
S. Has a Special Permit/Vadance/Finding ever been issued for/on the site?
NO DON'T KNOW t, 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
Mir N� � � -
WAMLT NTACT PERSON: (�
DEPT OF gL� DRES H NE:
Td5
PROPER it,I;bC A TION: xaz
MAP PARCEL: G ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION_CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM EU.I.E.11) OUT
Fee pnid
lRifflding Permit Filled mit
Fee pnid
Remndeling Interior
Addition fn Fyisting
THE FO).,LOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
pproved as presentedfbased 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
Afealth Well Water Potability-Bd Health
it from Co�a ' Co
Signature of Building Wector Date
NOTE:Issuanoa of at zoning permit does not relieve an applioant's 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 authoritles.
Department: Reference No: BP-1998-0019
...................................
Building, Electrical & Mechanical Permits
•.. ...............•-----......---....................----..........--•--•-••••..........
Fee Type: Receipt No:
Roofing REC-1998-000022
...................•----.........-----•---.............................•-•--••••.........
......................................
Paid By: Paid in Full On:
Larry Yentsch T May 26 1998
........................ ue Y
Received By: Check No:
Linda Lapointe 572
•--------•..................................•---...................•-•--••-•-............
•-•.....................•--•----•...--
DEPARTMENT'S COPY Amount: $20.00
...........................
DEPARTMENT FILE COPY 101 NORTH MAPLE 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: / & I( Inspector: Tracking No.: Fee:
26 May, 1998 BP-1998-0019 Stanley Szewczyk 963569 $20.00
GIS #: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
1670 17C 034 001 101 NORTH MAPLE ST URB 17380.44
Contractor: License Type: Insurance:
Larry Yentsch
Address: License No.: Insurance No.:
101 N. Maple St.
City: State: Zip Code: Phone:
FLORENCE MA 01062
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1998-0020 $1,700.00
Description of Work:
Reshingle over one existing layer
GeoTMS 8 1997 Des Lauriers&Associates,Inc. Signature: