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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. ✓3 91 Alterations
NORTHAMPTON, MARA 19-L-�_ Additions
APPLICATI N FO PERMIT TO ALTER Repair
Garage
1. Location '° Lot No.
2. Owner's name i /.Sr _ Address P G i cj
3. Builder's name 4 ? J Address f` i^ic/
Mass.Construction Supervisor's License No. 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 y /
12. Type of roof
13. Siding house
14. Estimated cost:-
i.s z/
The undersigned s that the above s cnts are true to the best of his, her
knowledg d bel
r
4 Signature of responsible app icanr
Remarks
4'
-
6 ul'1 2 fflassachnsctlo
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMTEfffiAITON INSURANCE AFFIDAVIT
Olcense permlttee)
with a principal place of business/residenc, t:
Y�'(p h
(stmei city/statr/zip)
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 Number) (Expiration Date)
(Name of Contractor) (lnsurancc Company/Policy Number) (Expiration Date)
(Name of Contmctor) (Insurance: CompanyTolicy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additiorW sleet if neecvs ry to include information pertaining to all masers)
am a sole proprietor and have no one working for me.
( ) T am a home owner performing all the work myself.
NOTE:please be aware that whilo homcowncn who employ persons to do ma irifm a n a croagrictioo or repair work on a dwelling of
not moon than throe uniu in which the homooancr resides or ou the avunds appurtenant thereto arc not grna g4 000sidacd to be
employers under tho workcea compcussuon Act(GL152,ss I(5)),application by a homeowar for a licewe or permit may evidence the
legal ctatua of an employer under the Worlcee,Corn;xosation Act
I understand that a copy of this ctatcmcut may be for vntded to tho Dc;xutarnt of Industrial Acciden&Of600 of Instvancro for the
coverage va-irrcatioa aad that failure to acatre coverage uzxlct section 25A of htaL 152 can lead to the impos on of criminal ptmlties
consisting of a fine of up to S 1,300.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine of S 100.00 a day against mo
Signe this _day Ofd �*- 1 99 For dgmtrtr"—only
O Permit Number
j - 2&P# Lot#
S 'tture o LiceascclPcruuttee
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.
This col== to be filled in
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
&paved parking;
# of -Parking spaces
f fof Loading Docks
Fill:
vol-ume--& location)
13 . Certifi/at 'on: I ereby certify that the inform `on contai e herein
is tru c rate to the best of my know ge DATE: APPLICANT's SIGNATURE Lrd NOTE: Issu o o a zoning permit does not relieve an app oa bu den to oompty with .�4
4'1 zoning it ants and obtain ell required permits fro the of Health, Coinservation
Commies on, apartment of Publio Works and other applioable permit granting authorit;as.
FILE #
r �
�w
File No:
1-9r� i�
ZONING PERMI T APPLICATION (§10 . 2)
PLEASE TYPE/ OR PRJWT ALL' INFORMATION
1. Name of APP licant: /
Address: ,� I elep one:
2. Owner of Property: ewe
Address: G.. Telephone: r de —
3. Status of Applicant: Owner�ontract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# l � Parcel# District(s):
(TO B FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property _
6. Description of Proposed UseA'Vork/Project/Occupabon: (Use additional sheets if necessary):
7. Attached Plans: Sketch Ian 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)
Reference No: BP-1999-0164
Department: ...................................
Building, Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Roofing RE(.,'-1.999-000342
......................................................................................... ............................•.........
Paid By: Paid in Full On:
Robert Thibodo Wed Aug.,, 12,1998
......................................................................................... ..................•...................
Received By: Check No:
Linda Lapointe 6492
......................................................................................... ......................................
DEPARTMENT'S COPY Amount: $20.00
...........................
DEPARTMENT FILE. COPY 194 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: Inspector: Tracking No.: Fee:
12 Aug, 1998 BP-1999-0164 $20.00
GIS #: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
1531 17A 223 001 194 NORTH MAPLE ST URB 12806.64
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
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0287 roofing $1,000.00
Description of Work:
STRIP & SHINGLE GARAGE ROOF
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: