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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location 130-132 High St . Lot No.
2. Owner'sname Joe pellitier Address 279 Colesmeadow Rd. , Northampton
3. Builder'sname Edward T. Corbett Address 61-63 Brookline Ave, Holyoke
Mass.Construction Supervisor's License No. f Expiration Date /
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
13. Siding house Vinyl
14. Estimated cost- $ 5,000.00
The undersigned certifies that the above statements are we to the best of his, her
knowledge and.belief.
t
Sgnaw a of responsible app icani
Remarks
Bea o of 'Nart4alli ball
7MKS%a chn5cl Is
u. m O' L 1,998 EPARTMENT OF BUILDING INSPECTIONS
2 �L-Main Street ' Municipal Building
DEPT tt3 Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE Ar, t A.VIT
I _,Edward T. Corbett
(li cense,Jpermi ttee)
with a principal place of business/residence at:
61-63 Brookline, Holyoke, MA (phone#) 585-0953
(strr city/stafelap)
do hereby certify, under the pains and penalties of pegury, 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 Company/Policy Numbcr) (Expiration Date)
(Name of Contractor) (Insurance Company/Policv Number) (Expiration Date)
(Name of Contractor) (insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attadt additioml shoot ifneceuuy to ioclude information pertaining to all ooatnn rz)
(g) 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 whilo hoc=wvcra,Ab0 cmplaY per,.=to do amintcamc, O=tnictioa or repair work on a&vclling of
not mote than throe units is winch the homoowncr raid,=or on the vouais apputtemrrt thereto am not wally coasida ed to be
employers undo the workers oompcos4on Ad(GL152,ss 1(5)),appiication by a hotncown=for a license or permit may eviduooe the
legal statua of an employer under the Worker's Compensation Act
I under i d that a copy of thin rtatemmt may be forwarded to the Departmrnd of 1nd�,biel Ao6dw&Ogee of Iffnuaooe for the
covattge verification and that failure to secure covc'raga raider section 25 A of MGL 152 can Iced to the inxpos Od of criminal penallics
waist mg of n fine of up to 51,500.00 ancVor ixrzpriso�of up to one y=and Civil penalties in the form of a Stop Work order and a
fine of 5100.00 a day against ma.
For depot—W use only
�G permit Number
/ Ivfag# Lot#
.,, Si a i ermittee
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.
Thi: aolwa to be filled in
by the Banding Department
Required I
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L• R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area menus bldg
&p?x,ed parking)
# of -Parking Spaces
#` 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 SIGNATURE
NOTE: luouanoe of a zoning permit does not relieve an M-PP*-1 r66AVal burden to oornpty with all
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission. Department of Publio Works and other applioable permit granting authorities.
FILE #
4
1 JUL 2 1998 /v
i File No.
z
N T ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: Edward T. Corbett
Address: 61 Brookline Ave . Telephone: 585-0953
2. Owner of Property: Joe Pellitier
Address: 279 Colesmeadow Rd . Telephone: 586-1767
3. Status of Applicant: XX Owner Contract Purchaser Lessee
Other(explain):
4. Job Location- 130-132 High St , Florence, Ma .
Parcel Id: Zoning Map# n C_ Parcel# I L/ I_ District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMEN
5. Existing Use of Structure/Property 2 family
6. .Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
r � roofin
n �
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/Vadance/Finding ever been issued for/on the site?
NO DON'T KNOW XX 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 XX 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)
Reference No: BP-1999-0110
Department: ...................................
Building,Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Vinyl siding REC-1.999-000180
..........6� ...
....... ................................................................
Paid ...........................
Paid in Full On:
Edw.ard T Corbett Fri Jul 24,1998
........... ..... .......................................................................
. ..... .....
Received By: . . ...Ch eck.No......•..............
Linda Lapointe MONEY ORDER
.........................................................................................
......................................
DEPARTMENT'S COPY Amount: $40.00
.....................DEPARTMENTFILE COPY 132 HIGH 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:
28 Jul, 1998 BP-1999-0110 $40.00
GIS #: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
1774 17C 141 001 132 HIGH ST URB 5488.56
Contractor: License Type: Insurance:
Edward T Corbett HIC
Address: License No.: Insurance No.:
P 0 Box 6241 119488
City: State: Zip Code: Phone:
HOLYOKE MA 01041 (413) 585-0953
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0151 vinyl siding $5,000.00
Description of Work:
SLATE REPAIR& INSTALL VINYL SIDING
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: