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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
• ' APPLI ATI N FORPERMIT TO ALTER Repair
A Garage
Location s r`ry y t Lot No.
�'Owner's name t i s T"o 1-f .Q S Address .gene as p
,_,3- Builder's name On v ( !) Eo< 7 C) (L 5- -dress 3.2_ L/)U t�, r f
:,Mass.Construction Supervisor's License No. 'Expiration Date
4. Addition
5. Alteration
tV
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
vl"4. Estimated cost-
The undersigned certifies that the above statements are true to the best of his, her
kno edge ar}d belie!'
Signature of responsible appicant
Remarks
��ttAAlpy,
O O
g� kltl 6 ,1995 Cr r laf 'Wiazt4alnytun
mm _
f+`ass arllrmettd
m DBPt1RTMH?',U OP BUIL.DrNG INSPECTIONS
212 Main Street ' Municipal Building y
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE ATTMAVIT
(li censerlpermi ttee)
with a principal place of businesslresidence at:
L,11C t� C f (phone#) a a�6
(streci/city/state/2i p)
do hereby certify, under the pains and penalties of perjury, that:
O 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 Contoarry/Poliicy Number) (Expiration Date)
(Name of Contender) (Insurance comp'ny/Pohc-'r Ntirnbu) (E�mmtion Date)
(Name of Contractor) (Inatranc-- Compa- y/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additioml shed Lfnoccz to mdude information pertaining to all ooaractors)
/am a sole roprietor and have no one working f
p g or me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that whtlo h mcoµvcrs wtx}employ pa-rom to do auLiat �mustuctioa or repair work on a dwelling of
not more than throe units La which the homoowacr resrdca or oa the grounds apputtenjtnj thereto arc not 6 fiY ooandcrcd to be
employers under the workct's compcas4co Act(GL152,s l(5))�application by a homcow=for a Uccax or permit may cvidcnce ttx
legal rtatrra of en employer under tha Workda Compensation AcL
I understand that a copy of thin rt3temend may be lorv4vxded to tho Dcparto�of Industrial Acci&=&Offioo of Inwnnco for the
coverage verification and that failum to scatre covcrago under scctioa 25A of MOL 152 can lead to toe'imposition of criminal penalties
comiuing of a fine of up to S1,300.00 anNor imprisonment of up to one year and civil penalties in the fans of n Stop Work Order and a
fine of SIQ0.00 a clay agniasl ma
��' For&pvtarrhil use 001Y
Permit Number
r'
Map#{ _I at#
ilaahire of Uccnscc/Permittce
10. Do any signs ebst on the property? YES NO t/
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 colu= to be filled in
by the Bstilding 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
&pai,ed 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 know 7edge. r�
' AI
Ll "A E: L CANT's SIGNATURE
NOTE: is-su*no4o of a zoning permit does not relieve an a lioant's burden to oomply wltl���ll
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applicable permit granting authorities.
FILE #
AUG 6 4998
Fi 1 e No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. lgame of Applicant: i�'i rte° ( lb'L
-Ad-dress: e ephone:
2. Owner of Property:
Address: 2& Telephone:
2
3. Status of Applicant: ner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property S
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 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)
Department: Reference No: BP-1999-0162
...................................
Building,Electrical & Mechanical Permits
A ................*.......................................................
Fed e: Receipt No:
Roofing REC-1999-000340
........................................................................................
...... ...............................
Paid By: Paid in Full On:
David Fortier Wed Aug 12 1995
.........................................................................................
......................................
Received By: Check No:
Linda Lapointe 2584
.........................................................................................
...........................•..........
DEPARTMENT'S COPY Amount- $20,00
.......................•...
M"PARTM ENT FILE COPY 366 ACREBROOK DR
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-1999-0162 $20.00
GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size:
5033 29 309 001 366 ACREBROOK DR URA 10018.8
Contractor: License Type: Insurance:
David Fortier HIC
Address: License No.: Insurance No.:
32 Laurel St 103999
LkE State: Zip Code: Phone:
NORTHAMPTON MA 01060 (413) 586-8965
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0285 roofing $3,200.00
Description of Work:
STRIP & SHINGLR ROOF
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: