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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 5-2n-o/ Alterations
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NORTHAMPTON, MASS. l9� Additions
' APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location � Q �`Gi�C lib' rn 5 � J �CI, 0/ Z Lot No.
2. Owner's name f E. ;f►(t cy���/ Address_.F-Foy, (-ay2A1 S M, Q/() L
3. Builder'sname -Ci J� �/� s� A0e)Fkt-,(- e2� (12, Address_L2y_ 13(1466S ST,/ /RA
Mass.Construction Supervisor's License No. Z) (D 6 30 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
14. Estimated cos •-
Z'76), 00 The undersigned certifies that the above statements are we to the best of his,
knowledge and belief.
,X,��4
nature of responsible app icant
Remarks 12-F Ana a PL—r 1 pf1r 1` e ti vZ S
i
�0 4 0
� MAY 2 51999 ,� �asaxrFittsrlla
m . TMENT OF BUILDrNG INSPECTIONS
DEPT OF 8UiL1 ';G l SPEGTj 2 Main Street ' Municipal Building '.o
�`ORtf{f fO 'IA 01060 Northampton, Mass. 01060 y
WORKER'S CONITENSATION INSURANCE tk. t r AVIT
(li censedpermi flee)
with a principal place of blisiness/residence at-.
l2 l GGS ( � - /(- n� A,, d ` (Phone#) 5 2`I'O/2e
(strc~-- city/stab/ap)
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:
(Insu=C'-' Company) (Policy Number) (Expiration Daze)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following workers compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(-Hach additioml thect ifneccssary to iochrdc iaf"iaxtiou pertaining to all coo Ofj)
I am a sale proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please b c awam that whilo homeownm who employ periom to do xijd� ctioa or repair work on a dwelling of
not moca than tbroo units in which the homoowncr raider or on the grouser appurttuant iberdo arc not gcocraily oomidcrcd to be
employ--11 the vmrlccr'a oompauaiion Act(GL152,ss l(5)�application by a homeowner fora Haase or permit may evidence the
legtl etub-"of an employor under tho Workoes Compemation Act.
I understand that a copy of this rulcmeas may bo forwarded to tho Dop-tram of Industrial Ao6d-&Office of Iawranoo for th*
coverage vaificadon and that fadure to&cane oovaago under soction 25A of MOL 152 can lead to tbo'impost -of criminal pe l'Wel
oomistmg of a&ne'rof up to s 1,5oo.00 armor kTr6omixzu of tip to one year and avta pcanllies in the form of a slop Work Order and a
film 0(5100.00 a day agniast tux
Foc dcpartnacrsl uao only
_ Permit Number
I'ot#J
Srrgnaturo ofLi ermittcc
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 COMPLE'T'ED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This colnmm to be Pilled in
by the Building D&partment
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
&paved parking)
# of Parking Spaces
f 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.
DATE: /Z y��� APPLICANT's SIGNATURE-
NOTE: Issuanoo s of a zoning permit doe not relieve an applioanva tAArdan to comply with L$11
zoning requtraments and obtain all required permits from the Board of Health. Conservation
Commisslon, Department of Publio Works and other applionble permit granting authorities.
FILE ,
MAY 2 5 L . J File qq—leed
/
r._
PERMI T APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 40/u L E, 511,02 12 A e
Address: o 13 /CGS 57 Telephone: _5 'Z17-0/20
2. Owner of Property: P
AT I'm/I&'L"F Y �
_ t)
Address: L114r®t igQ, Telephone: `f5 3 ^ 2�
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): ]
4. Job Location:
Parcel Id: Zoning Map# Parcel# 7 District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5, Existing Use of Structure/F'roperty
6. Description of Proposed UseNVorkJProject/Occupation: (Use additional sheets if necessary):
c ave 4
woa r2
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)
28 FOX FARMS RD BP-1999-1002
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A- 149 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:roofing BUILDING PERMIT
Permit# BP-1999-1002
Project# JS-19990779
Est. Cost: $1280.00
Fee: $20.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: DE Sheppard Roofing 066306
Lot Size(sq ft.): 14810.40 Owner: MAHONEY PAT
Zoniniz:URA Applicant: DE Sheppard Roofina
AT., 28 FOX FARMS RD
Applicant Address: Phone: Insurance:
17 1/2 Briggs (413) 529-0170
EASTHAMPTON 01027 ISSUED ON.'512611999 0:00:00
TO PERFORM THE FOLLOWING WORK.-RECOVER FLAT DORMER ROLL RUBBER
POST THIS CARD SO IT IS VISI BLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Final: Final:
Rough Frame:
Gas Fire Departmct,t Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAX BE REVOKhij 1SY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGUL,,�"AONS.
Certificate of Occupancy Signature
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 5/26/1999 0:00:00 $20.00
212 Main Suet,Phone(413)587-1240,Fax: (413)587-1272
BUitding Commissioner-Anthony Patillo