36-142 w I r
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 66 6 gj6�� Alterations
NORTHAMPTON, MASS. `� 19_ r r Additions
Repair
APPLICATION FOR PERMIT TO ALTER
/� Garage
1. Location 6t> 72 o o e-s � (-o d{ Gee Lot No.
2. Owners name ,9 Address 300 6260A
3. Builder's name�� u t:1 �y 2-T 4 Aa Address -2- Gft 0&fuz s i-
Mass.Construction Supervisor's License No. 8 6 q0)-(, Expiration Date 3 / / d
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 l 2 I ?d D`-9 /U oy 5(4 tom✓E t��5
13. Siding house
14. Estimated cost-
The undersigned certifies that the above statements are true to the best of his,
knowledge and belief. �
Signature of responsible app,icant
Remarks
�� �° :a Crz#�r ladz#�ttntun
9 � �asartcitnsttts
2 41999 - _
.-DEPARTMENT OF BUILDING INSPECTIONS -
�,:-„ 212 Main Street ' Municipal Building
Northampton, Mass. ' 01060
WORKER'S COiNPENSATION INSURANCE AFFIDAVIT
N perm_ittrle)
with a principal place of business/residence at: 016 L O
L olz(z Si �or0,� (phone#)
(Street/ci ty/sta&2:i P
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:
(mince cow) (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) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Poky Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach addildooA sled ifneccaary to iod iaformarioa petLining to all 000tracton)
(')"'I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:ple n be aware that wbilo homom-mn who employ pasom to do,,,JL;.,e�crosruction'or repair work on a dwelling of
not more than throe units is which tbwe homeowner resides or oa the grounds appucteawi thereto are not gaoaally ooaridered to be
employers under rho worker's compensation Act(GL152xs l(5))�application by s homeowma for a licc>vc or permit may-id-oc the
legal etat,ri of an employer under the Workees Compemation Ace.
I undentaad that a copy of thu datcmetn essay be forww dad to the Depub=ea of I.&,3ftial Apd&rty Ot';ioe of Irrnaaooe for the
novas ge verification and that failure to secure covera.go under section 25A of MGL 152 an lad to the iu�sibon of criminal penaltirs
comistmg of a-fine bf up to S1,500.00 andlor imprisoamcat of tip to one yar sad civr7 pmaltia is the form oCa Slop Wade Order dada
five of 5100.00 a day agsinst taG
Fori;PxrtaVuLd use only
Permit Number
Lot if
- y S. of LicenswiPermittee
n
10. Do any signs ebst 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 colt to be filled in
by the Baildiag Departmeat
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L• R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lotarea minus bldg
&Paved parkingj
# of "Parking Spaces
f 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 knowleddge.
DA'Z'E: i Z '3 APPLICANT's SIGNATURE QA 4
NOTE: lssuano of a zoning permit does not relieve nn applioant's burden to oomply witix .all
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission. Department of Publio Works and other applionble permit granting authorities.
FILE #
AUr 2 A Ig"r
File No Anog 9
'ZOVING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: ola,LL , Q (�!,?12-
Tele hone:
Address: �l /-�CJ�,(?i,L S71.&J4,1 /3
p
2. Owner of Property: cJ 11
Address: 3LCU C"'' Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain)/ o'o,i, c F c-
4. Job Location: BOG /zoo G4's('J�� �.s•
Parcel Id: Zoning Map#_ �0— Parcel# District(s):
(TO BE FILLED IN BY THE UILDING DEPARTMENT)
S. Existing Use of Structure/Property ��i'w (o L ft �A!�j et- Y
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
S 12( P /C 0 o"�<-7 'Q ti ® k i'� Zdocz
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)
300 BROOKSIDE CIR BP-2000-0197
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:36- 142 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:roofing BUILDING PERMIT
Permit# BP-2000-0197
Project# JS-2000-0319
Est.Cost: $2600.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: David Fortier 103999
Lot Size(sa.ft.): 15202.44 Owner., BOND DAVID G&CAROL H
Zoning URA APP licant• David Fortier
AT: 300 BROOKSIDE CIR
Applicant Address: Phone: Insurance:
32 Laurel St (413) 586-8965
NORTHAMPTON 01060 ISSUED ON.812411999 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Final: Final:
Rough Frame:
Gas Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 8/24/1999 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo