07-017 (3) t, ,.�,.._ -,
Npy 5998 H
File No. , •? o
t��
c nrdNING PERMIT APPLICATION (§50 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
I. Name of Applicant:fp 3„ " e�y'4-6,4,„,,,,,6,..,
Address:, l .?s_ 5 7 Telephone: SQ c - 5--z. 2 '
2. Owner of Property: firs j"j�
' en e S
Address: ? G (9 , L(,rr t h _.! se"anti Ere/ Telephone: PrG - 2 !, C`/
3. Status of Applicant: Owner Contract Purchaser Lessee
5e Other(explain)/:: L ?/. • . j+
4. Job Location: _3._.‘,.0 //Jn�l' /`nrsn /CI
�
y p
Parcel Id: Zoning Map# j ParceI# tt_
_ Oil District(s): Ater
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property lfe rw..e
6. Description
PDescription of Proposed UseMJork/Project/Occcuupatlon: (Use additional sheets if necessary):
.........7 /iing c- (mem V-- IA tioe Jt.iS
7. Attached Pians: 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 PermitNariance/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)
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?YESNO
IF YES,describe size,type and location:
11 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This column to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - front
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&peved parking)
# of Parking Spaces
/l sof Loading Docks
Fill:
-(volume-& location)
13 . Certification: I hereby certify that the information contherein
G is true .nd accurate to the best of my knowledge.
DATE: — cAPPLICANT'S SIGNATURE
NOTE: I, - - o- of a zoning permit does not relieve an a Iloanrs bu en to oomply with all
zoning req irements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Pubilo Works and other applicable permit granting authorities.
FILE
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Zoning
Miscellaneous Additions.Repairs,Alterations.etc. Tel.No. Alterations
T"B' NORTHAMPTON, MASS. /f/3 199F Additions
}'*; APPLICATION FOR PERMIT TO ALTER Repair
r+" n / l/ /� Garage
1. Location 3 o NOfYh Fa r..-rs Rd Lot No.
2. Owner's name 006 Tn.,,P 5 /� Address 96 0�fa uvrh rani..., A l Q/a.'r(.,....„hw 01.
3. Builder's name Wesr,er., Man S j '�.r/Se..Cf Address ,3 C.,., 47 ragrirto. /yoran /2i,I
Mass.Construction Supervisor's License No. 0 3 46/, H Expiration Date r f/71 4 0-
4.
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
I I. Distance to lot lines
12. Type of roof
13. Siding house O e
R ePiF C c.o., cn QJiti de-cc, 5
14. Estimated cost-if, S 2 O. o
The undersigned certifies that the a ve statements are true to the best of his. her
knowled a,SA7 belief. ,(/�
"..'-
Signature of respon able appuca l
Remarks
•
p, .a \
a pt+ 44::1- '.qr \trt of dazflianc{ folt i�
_ � -:
\\ - p-timi TMFNT OP BUILDING INSPECTIONS _ • —�`
}1 ' 212 Main Street ' Municipal Building
I Northampton, Mass. 01060 e: WI
_
WORKER'S COMIPE SA ON INSURANCE Ark LI/AVTT
l,' Ceri271.4 'J
(Iiceusccipermit ee)
with aat:principal place of business/residence
6 3 6q,7- S/x (1-36,57-/on-2,70-.7 "770 .
(Phone ) . --d5,
G- 7--). a -7
(sal/city/swd'np)
• do hereby certify, ander the pains and penalties of perjury, that: •
() I am an employer providing the following workers compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Nut) (Expiation Date)
O 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:
•+ (Durno of Contractor) Ens-mance Comoaay/Potic Num[nr) Ramo-anon Datc)
(Name of Contractor) (lsa=_,cc Compalr/Potent Numb_r) (Esse-aeon Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expilation Date)
(Nc of Contractor) (Insuranc Company/Policy Number) (Expiration Dale)
Nara timil..`.act Joa..-...ry a wJt4 i- tw
ren�wicu p nicg o carr=Con)
( I am a sole proprietor and have no one wodang for me.
7
() I am a home owner performing all the work myself.
NOTE:plesc be attract that virile bomcotccn"bo aoyloy parom to do mtact'cc mwniaim or rryair work on a dtttWoa ar
not mac tba Ono calli in which the ha ce aara:c or cc tbc goods WNdra ct the do cc rat G ocalty o c,idad to ba
wmloya,ander tba uw cakprtim An(GLI52snt(5)). pplintion by.bommoaa Inborn cc pcnnd may .& -Cbe
Icgalet+..ofm copIoyer andertho Worker's Compoa tion AnL
•
I cWmtaod tht a copy ofWis catazocancyb.rvwvded to tic Baynton of'cluck!Ati!Oboe of haaunoe.1 tb
cova,gc raifiotioo and nut fail=to cave covcno nada,xtioa 25A of MOL It au lad to tba''ampddsm of cricket fe aiuc, r
mdwtg of cfmc ufup toSl}00.OQ=doe prvocmcm ofup to one ymr and aril p®Na in tic form ofa Stop WarkOrda and.
Ln,ofstoono spay,®,intoe.
For dgci mia"°ooy
1/ 3
P n .it Ntnvbe
c Ll._. : r,Ojt� -
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Department. Reference No: BP-1999-0470
Building, Electrical & Mechanical Permits
Fee Type: Receipt No:
replacement windows 12EC-1999-001272
Paid By: Paid in Full On:
Western Mass Siding& Roofing Fri Nov 06,1998
Received By: Check No:
Linda Lapointe 2347
DEPARTMENT'S COPY Amount: 520.00
DEPARTMENT FILE COPY 360 NORTH FARMS RD
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:
06 Nov, 1998 BP-1999-0470 S20.00
GIS #: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
236 07 017 001 360 NORTH FARMS RD RR 11238.48
Contractor: License Type: Insurance:
Western Mass Siding& Roofing HIC
Address: License No.: Insurance No.:
63 East Street 105630
City: State: Zip Code: Phone:
EASTHAMPTON MA 01027 (413) 586-5227
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0903 windows replaced $1,520.00
Description of Work:
INSTALL REPLACEMENT WINDOWS
GeoTMS®1997 Des lauriers 8 Associates,Inc. Signature: