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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. DeC 19_Z Additions
/
APPLICATION FOR PERMIT TO ALTER Repair
1 r
Garage
1. Location 698 BC)A-�-s P, Lot No.
2. Owners name Ner,, y I?elA4r/n/ev" Address S/ —
3. Builder's name �d C O TT- Address y -e-e,,;/ J f_
Mass.Construction Supervisor's License No. 0&2 ySa Expiration Date
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
13. Siding house V/Alt, S'/CJ/�✓�
14. Estimated cosa?6`t 7`5-4v-
The undersigned certifies that the above statcments are we to the best of his
knowledge 'and b f.
Signature of responsible appicant
Remarks
4��MPT
•O�O�
s a Crif� of nx I�ttnt nrl
$ 6 .�lasaacEtasctts 4
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060 '
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(licensedpermittee)
with a principal place of business/residence at:
�_L�u-u s� .� J��✓ 1'114 (phone#)
(strcWcity/staW2ip)
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)
( ) 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/Policy Number) (Expiration Date)
(Name of Contractor) insurance Company/Policy Number) (Expiration Date)
(attach additiocal sheet ifneoeaary to inolade infac on pertaining to all oodradon)
( 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 whito homcowaas who employ pcmm to do�;meas= eoastrvWon or repair vlmk on a d%%LUng of
not n"o than throe unit+in which the homeowaarresida or on the vvun&appurtenant tbwdo are not getxsalty comidered to be
employes under the wa riceft cornpeaudic a Act(GL152.=1(5)1 application by a homeow=for a lkc=cc permit may evidraoe tho
legal atabu*fan a wioyer under tba Wodcaes Compemetion Act.
I understand that a copy of this awrewaA may be forwarded to tba Departmooe of Indatrial Aoeidmts•OTm of rasuranoe for the
coverage vari&catim and that failure to seaze ooverago under section 25A of MOL 152 can lad to the imposdion ot•aiminat peaaltiea
oomisting of a Sae ofup to 51,500.00 and/or imprisowncra of up to one year and civil peasltia in the foam of a Stop Worts Order and a
fim of 5100.00 a day against ma
For depot omW use only
Permit Number
�•Z �9 Map# IA#
Signature ofLitxnsmee- -tice MEE
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 Department
Required I
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parkingi
# of -Parking Spaces
f of Loading Docks
Fill:
(vo1-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: 112,-4 _15151 APPLICANT's SIGNATURE
NOTE: Issunnoa of a zoning permit does not relieve an appiioant's burden to oom M
zonin Pty wltt� all
requirements and obtain all required permits from the Board of Health. Conservotion
Commission. Department of Publio Works and other applionble permit granting authorities.
FILE #
I
In
6 1999
P(OF UII D!r PECTFile No �`' ';,:>�
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: Col rare jc_T
Address: 7 we Telephone: 5�
2. Owner of Property: , &'Ujff n/t�
Address: of gr �l/.Q /� /1 Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: 51+^`x!
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):
�✓r�r� Si&"I'W'o r
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 PermitA/adance/Finding ever been issued for/on the site?
NO DON'T KNOA1 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)
898 BURTS PIT RD BP-2000-0588
GIs#: COMMONWEALTH OF MASSACHUSETTS
^ARLBlock:36- 185 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:vin is BUILDING PERMIT
Permit# BP-2000-0588
Project# JS-2000-1053
Est.Cost:$8145.00
Fee: $25..00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Ed Corbett Jr 116069
Lot Size(sq.ft.): 31 232.52 Owner: REYMOND WENDELIN&HEIDI ERIKSON
,Zoning: SR Applicant. Ed Corbett Jr
AT. 898 BURTS PIT RD
Applicant Address: Phone: Insurance:
4 Reed Street (413) 586-5192
NORTHAMPTON 01060 ISSUED ON:12114199 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL VINYL SIDING
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Jnderground: 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:
f"I'luilding 12/14/99 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo