38B-099 (5) Reference No: BP-1999-0248
Department:
Building, Electrical & Mechanical Permits
Fee Type: Receipt No:
Roofing REC-1.999-000590
Paid By: Paid in Full On:
Richard Labombard Mon Aug 31,1998
Received By: Check No:
Linda Lapointe 2277
DEPARTMENT'S COPY Amount: $20.00
DEPARTMENT FILE COPY 42 MUNROE 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:
31 Aug, 1998 BP-1999-0248 $20.00
GIS #: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
7600 38B 099 001 42 MUNROE ST URB 5401.44
Contractor: License Type: Insurance:
Richard Labombard HIC
Address: License No.: Insurance No.:
119 Park St 108204
City: State: Zip Code: Phone:
EASTHAMPTON MA 01027 (413) 527-7427
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0516 roofing $900.00
Description of Work:
STRIP & SHINGLE GARAGE ROOF
GeoTMS®1997 Des Lauriers&Associates,Inc. Signature:
-D EPROWE -
PIE 3 11�
File No.
DEPT OF BUILDING INSPECTIONS
NORTHAMPTON,MA 01060 -MING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: )4C/�`X,D 4O .d/if ,1
Address: 7// (, V'/ /, e%iy,,0C 2''Telephone: Sa? ? 'A7
2. Owner of Property: \. 42 %C:if/Address: 4L /4)UNZI ' >77 Telephone: 5-Thor 92-4 /1
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: //,_ k vA/weC $7
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
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 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? 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 filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- 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 tru and accurate to the best of my knowl de.
DATE: //9 APPLICANT's SIGNATURECIc LX%
NOTE: Issuanoe of a zoning permit does not relieve an applioants b(rden to oompty 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 #
•
I . Liiiarnp±an
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ni le DEPARTMENT OP BUILDING INSPECTIONS = t j
IEPT OF SUILU'l:r t` ,i;S __I f
. NORTHAM?TCi'__ 212 Main Street ' Municipal Building -,
Northampton, Mass. . 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
gfc#,w_____Laxim 4.fri
(licensec/permitt e)
with a principal place of business/residence at:
8 / / , Cj// F��4" Md.��� , . (phone/0 59/77 y,L7
(ste=t/city/statelap)
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:
(Insurance Company) (Policy Number) (Expiration Date)
1
( ) 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) (Insuranc: Cornyany/Policr Nutn±er) . (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheet ifner-r„vy to inc'uc.e information pertaiuiag to all ccotrac:o:s)
( 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 ucEle homcoxnca:ttw employ persaas to eSo mamtc-,, vuioo or repair work on a chvcning of
not more th n throe units in which the homeowner resides or oo the grounds appurtenant thmtto arc not generally coasidcrcd to be
employers under the worker's oempeasatiea Act(GL 15ass 1(5)),application by a homeowner for a lic arc or permit may cvidcoce the
legal rtatra of an mcployor under the Wordcor'a Compensation Ad.
•
I understand that a copy of thin rt,t.m,nt may bo forwarded to the Departmcot of Industrial Attideat:&Of600 of Iazurzaoo for the
coverage verification and that failure to sontre coy crabo under pion 25A of MOL l52 can lead to the'imprn*tioa of criminal penalties
com 'o istiug of a finef up to S 1,500.00 and/or imprisomiocni of tip to one year and civil penalties in the form of a Stop Work Order and a '`
fine 0(5100.00 a dry against me: .
For d�tinc�l tun only
WWI/
� Permit Number .
y M •2vf:apII Lot . , . .
ipnature of I..i eisniU c Ll3t�e
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
;'%r NORTHAMPTON, MASS. '�/�� 19 % Additions
Fri" APPLICATION FOR PERMIT TO ALTER Garage g
1. Location 901 /yJU///f oE Si Lot No.
2. Owner's name 3 e kaC�51 Address /) /�"Ate,
3. Builder's name /t/�f1/9rii �,971 14fcc/ Address //f lr X� l
Mass.Construction Supervisor's License No. el S 15"3 /6 Expiration Date fir!%e l',
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 4 Sl',4/9L T 5h9//A'' re 6- GCE- W-e-‘-il '% 04.,' C F
13. Siding house
14. Estimated cost:- We/. ee
The undersigned certifies that the above statements are true to the best of his, her
knoiIWä
e lief.
Signature of responsible applicant
Remarks