18D-040 (43) U ,
Department: Reference No: BP-1999-0385
Building,Electrical & Mechanical Permits
Fee Type: Receipt No:
demolition REC-1999-000997
Paid By: Paid in Full On:
Pride Convenience Inc Tue Oct 13,1998
Received By: Check No:
Linda Lapointe M03303
DEPARTMENT'S COPY Amount: $10.00
DEPARTMENT FILE COPY 17 Damon Road (Pride Convenience)
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:
BP-1999-0385 $10.00
GIS #: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
8944 18D 040 001 17 Damon Road(Pride Con HB 42209.64
Contractor: License Type: Insurance:
Pride Convenience Inc CSL Workers Compensation
Address: License No.: Insurance No.:
246 Cottage St 038811 WC29734-013
City: State: Zip Code: Phone:
SPRINGFIELD MA 01104 (413) 584-9485
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0729 demolition $5,000.00
Description of Work:
Demo Canopy over pumps
GeoTMS®1997 Des Lauriers&Associates,Inc. Signature:
File#BP-1999-0385
APPLICANT/CONTACT PERSON Pride Convenience Inc
ADDRESS/PHONE 246 Cottage St Sprfld 01104 737-6992
PROPERTY LOCATION 17 Damon Road(Pride Convenience)
MAP 18D PARCEL 040 ZONE HB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid m0 13/6 —
Type of Construction:
New Construction
Non Structural interior renovations !�
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Occupant Statement or License# li
3 sets of Plans/Plot Plan
THES,PrLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based 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
" ac Approva4Board of Health . Well Water Potability Board of Health
Permit from Conservation ission
a/7
Signature of Building 4115cial Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
Oc't 06 98 02: 56p p. 2
'5 V 15 U N II'
6
I i OCT 13 i998 li _
File No.� �/ r , tJ1G�r
DEPT OF BUILDING INSPECTIONS.
CA
rIORTI�ar�PTora MA o>oso NING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: ��
Address: 3 7 f(.�r ..5�"- Telephone: J ' ?7'
2. Owner of Property: "�-e-rc'e- Cer")...-^`��^-.s'v`--.._
Address: '2 V6,, Ce, /,-S/'1-G, Telephone: '/ 3 737 / e5'
3. Status of Applicant: . , Owner Contract Purchaser Lessee
Other(explain): �7 ^'�)/�
4. Job Location: 1 t Y�l� _
Parcel Id: Zoning Map# Q Parcel# District(s):
(T BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property G�t�uy ®`v'_ i,a_-
6. Description of Proposed Use WorkJProject/Occupation: (Use additional sheets if necessary):
Dom„-7,-
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 PermitVariance/Finding ever been issued for/on the site?
NO DON'T KNOW YES V IF YES,date issued: _
11- 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 DONT 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)
, Oct 06 98 02: 57p p. 3
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 sons 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 column to be tilled is
by the Duiidi.ag Doper town t
Required
Existing Proposed By Zoning
Lot size
Frontage
•
Setbacks - frrint
' I
- 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:
(vol-ume -& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: < 2—l' "l, APPLICANT'S SIGNATURE
NOTE: tasuanea at a zoning permit does not rellere an applicant's burden to comply with ail
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commimsian, beparti lent of Publie Works and other applioable permit granting authorities.
FILE #
. Oct 05 98 02: 57p p. 5
•
b�STO En
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r.c ' t i Err �l2TIT LITT 't '�'
OCT 13 998
„
raeechttsetls
MRT NT OF EUII22f.to INSPECTIONS �_
�'�:-'�"" DEPT OF BUILDING 1N�P g
NORTHAMPTON M...00 . �-
Main'Street • Municipal 2uilding ~�\
Northampton, Mass. 01060
WORICER'S COMPENSATION INSURANCE AF IelDAtiTT
--
(linear ecipermi tt ee)
with a principal place ofbusiness/residenc-e at:
(phone#) 772--6 yjoL
.C.-1(P)rteici /sue zip)
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:
.w c 7 3 via
(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 or Contractor) (Insuraocc Conrpany/Policy Nurticc:) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Nwnber) (Expiration Date)
(Name of Contractor) (Insurance Compaay/Policy Num►yr) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional alxct ifom-n=rym ioelode infrXmAtioe perairc;,I.g to all rxatradora)
( ) 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 while boctteoween who employ perums to do w w•"•+- caatructioa'ar repair work oe i dwelling of
not morn than three units is which tba homeowner residci oc m the gmunat avpurt :Sado arc col etn..alty matidacd to be
esnploycra under the worker's o -x.lim Act(GL152.,s3 I(5)),application by a bcmmwvir for a lionise or pm-mit may cvidcnoc the
legal rtuua of en employ«.under the Worker's Compomiiioa Act
I aadctstaad that e.Dopy of thla aateme to shay bo farti ordoi to taw t>apar tmeart of tom,.cial Ascickeza.OfSoo of Ina r.aoa for tb.
eoventgo nai@caiion amid thal railcar to so ure covcrago under sc caeca 25A of MOL 152 estl 1a+d to t6d ieopasi ion of cri.mioat penalties
Doesistleg eta'froa'of up to S1.5O9,00 aadlx i=prisoacoent of up to ore year and 0vil paaaltia is the foca of a Stop W eric order aid a
fine of S LOO.00 a day eg teat me. '•
For dcpasiinmtal txae mlY
p Permit 2ltlmes b •
• • t ' 7tdi�® •
Mill _ Lott('
Signabnib o'I,iocnscc/Pcrmitcc Late
Oct 06 98 02: 57p p, 4
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 23 7 6 P -)— Alterations
'-,10 NORTHAMPTON, MASS. ( /a' 19. Additions
�"`-� rI APPLICATION FOR PERMIT TO ALTER Repair
- —Cr— arage
I. Location 3 7 r O d"- Lot No.
2. Owners name '"^~ - 1..".0 `?___" "— Address c.)-�� C...-r-C � "c? f , i� 2
3. Builder's name t `( Address e'(
Mass.Construction Supervisor's License No. 62 2e f// Expiration Date CS:2-" "tom 'L
4. Addition
5. Alteration
b. New Porch
7. is existing building to be demolished? V --("'
8. Repair after the fire
9. Garage No.of cars Size
ID. Method of heating
11. Distance to lot lines
12. Type of roof
13. Siding house ¢�
14 Estimated cost- `�rc4..sv
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
122.7,.___Q y
Siyeotyre of responsible appucant
Remarks
NOV-03-98 04 :56 PM PRIDE r,_,,_ R g M 4 k37315852 P. 01
n ail ow 4a13
hiii 1r)
DEPT_ iONS
246 Cottage St., Springfield, MA 01104.4002
Tel. 413-737-6992 • Fax 413-731-5852
November 2 , 1998
Northampton Building Department
Via: Fax 587-1272
Attn: Stan
Re: 375 King Street , Canopy Demolition
This wi11 confirm that electric power to the canopy
being removed has been turned off .
Ma
Randy Heath, Electrician