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35-195 (5) v v o• � m a 3 ' Ozm CQ r Z Q� G t E o � Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MASS. 19 Additions APPLICa ATION FOR PERMIT TO ALTER Repair Garage 1. Location I `� U a2i 5 l" j� Kolb nn Lot No. 2. Ownee s name_T D,6 IE Z i q— 0 jZ.3 0 i 8 Jjt&7av Address it 31 46 3. Builder's name DAUf>> j`c:,-a l4.2 Address 2 A uj2,,Cc ,f f Mass.Construction Supervisor's License No. ti U 2 C 2(o Expiration Date 31 ro 4 2 i t 4. Addition 7, X a I 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 JFL 1?L 'r.2+ c 1 1. Distance to lot lines F 12-6,,.7 If 0, a RC- 3 2 l qAC k t1,0 12. Type of roof QSPlm r 13. Siding house 14. Estimated cost:- o�, Ou61, The undersigned certifies that the above tatcmcnts are we to the best of his, her knowledge and belief 4) 1 Signature of responsible app icant Remarks a(tIAHP�. . ��'•>a� �4Z��Jbi11t�J�r1TT c 9 6 atxchnsctts ` DEPARTMENT OP BUILDrXG INSPECTIONS ^, 212 Main Street ' Municipal Building Northampton, Mass.' 01060 ' WORT=R'S COi ITEM SATION INSURA-NCE &F t A VIT � z X�• '� cJi �o2T ff�� (lic,�uet/permi ttcc) ninth a principal place of business/residence at: .. ... ....... (stsr�t/ci ty/statrhi p) do hereby certify, under the pains and penalties of penury, that: ( ) I am au employer providing the following vrorker's compensation coverage for my employees worming on this)ob. (insi=cn Coiapany) (Poticy NtLglL-- (Expiration Dare) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who hi=ve the followiog worker's compensation policies: :t (iTmc Oi Co,uncwr) (inS'�_�cc COII pwryfpobcr Nlunbcr) \ lC3C OII Date) (LN"ine of Con(i,ctor) (insu:.ice ComoanvRobc; Nuiac r) (EXDImuou Date) (Name of Contractor) (tnsuranc-- Compaay/Policy Numbu) (E),piration Date) (Name of Contractor) Gnsurancz— ComD y/Policy Number) (Expiration Date) (attach_,mitic4aA r.E'i if nCOQ+.Iy to tpCtU(k IGIClII1y!1CQ QC12 L•iiltl�1p O,U ooa:; q) ( am a sole proprietor and have no one worhno for me. ( } X am a home owner perforTning all the work myself. NOTE:plcisc be awcitc di-t wlsiio hom wuH Wt>o awicy pcciom to do c>a,�con zxu oa'or r4mir work oc i dfi c z Of ant mocc tau tbrco units is wbLich the botno -ocr rcW,4.=cc oa the grounds appurtcnnt the ct atc opt Ccnrrltty oomid=d to be emptoym under tbo wM+.e ocmp=,-iioo Act(G L151,m 1(5)),appria0oa by s hoa=vm r for a li0=3c cc permit may cvidcnoc the IcPI rtxbu of asa o=ployoc under dh Wockce,Coo?ponxLion kct_ I UaAcraand th t a copy of.thi6 cmt®ccd m y bo focwavded to tb-Dcpartmcnt of loL..shisl/.00dm&Otfioo of Irzsvrwoe fa tb. covaxgc vrrific:dion and tlut Utac to somm a vcr&V tmdcr st cljoa 25A of htOL 152 an lad to the inxpositioa of aimicA pc=Wl oomisszag Of a•fmc bf up to S 1,100110 an{S/or aalaisocmcai of tip to ooc ycar and 4iv�7 pc=iti a is the form Of a Step Work Otdcr and a ftno oC5100.00 a day L&UnA.me Fordgn�,only - � Pcimit-Ntu�ber .. Si ofL iocascclPcrmit3oc I . . .. ;-`_".4f✓.w�.""<`:'��,1{�,��y ' F 1 r}� y'•`� ''' `'yam. 3� at ' 4 T -- ft �o rVC�aa, �- T ATw -- ---- -- - - , _ - - -- - - - -- - --- ---- -- - I N$ULAVi CG�vC2QT' LS a � 71 00 0 O � o M _ x ML -o LU I UO - X v N - IVO fl 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. Thia colu= to be filled in by the Efuildi.ng Department (Required I Existing Proposed By Zoning Lot size 115-5-o Frontage 1 /( U Setbacks - frnnt - side L: R: L: `- d r R: 3�2 - rear Lid 1 t, � Building height 13 /D Bldg Square footage %Open Space: (Lot area minus bldg © &paved park_ngi F 5D0 # of -Parking spaces ht of Loading Docks Fill: -(volume -& location) 13 . Certification: I hereby certify that the information contained herein G is true and accurate to the best of my knowledge. DATE: It APPLICANT's SIGNATURE NOTE: luounno6e at a zoning permit does not relieve an app ioanYs burden to oompty With'4ill zoning requirements and obtain all required permits from the Board of Health, Conservation Commlealon, Department of Publio Works and other applioable permit granting authorities. FILE # .. . NOV 1 7 1998 Fi 1 ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: jlu 'Q �Q fza:'? Address: 31- (.riur, 'C Sf, Telephone: 2. Owner of Property: 14 t dJ j(F/Lttiy�7 Address: J( T1_ 13,2 a z�,T 90- Telephone: fi-yY- 3. Status of Applicant: Owner _Contract Purchaser Lessee Other(explain)/: Z 2Acr&,tn 4, Job Location: _t( � �✓U/�T5 �i>" /'C'D- Parcel Id: Zoning Map# 35 Parcel#_ 5 District(s): j (TO BE FILLED IN BY THE BUILDING DEPARTMENT) S. Existing Use of Structure/Property S�i 1r to L.1 �iF�zi`y � 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): 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 Permit/Vadance/Finding ever been issued for/on the site? NO DON'T KNO A 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) File#BP-1999-0493 APPLICANT/CONTACT PERSON David Fortier ADDRESS/PHONE 32 Laurel St(413) 586-8965 PROPERTY LOCATION 1182 BURTS PIT RD MAP 35 PARCEL 195 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid 2�L3 T e o�Non s Co �Structural interio Addition to Existing Accessory Structure Building Plans Included: Owner/Occupant Statement or License# 3 sets of Plans/Plot Plan ✓' THE F LOWING 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 ' Well Water Potability Board of Health ierm�•' ibrnConservation ommission Signature of Buildin ficial Date Note: Issuance of a Zoning pk►'Ait' eS 4t��l�e 'H 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. Reference No: BP-1999-0493 Department: .............••......•.•...••.••.•. Building, Electrical & Mechanical Permits ..•••.•.•.• ............................................................................. Fee Type: Receipt No- Building- Renovation ..• •....•----••••-•••-•-••••••-••-•••-•••--••••--••-••---••--•.......................... Paid By- Pa.id.i.n..Full..On: ........... ....David..I.�or.tier.............................................................. Tue Nov 17,1998 .......... .... ..... .. . ...... ..... Received By.- Check.No ................... Linda Lapointe 2703 ......................................................................................... ••••..•.•••••.•...•••.•.•••••.•••••... DEPARTMENT'S COPY Amount: $59.00 - -------------- l)l1'l1'ARTMl`.N'I' F1LF COPY 1182 BURTS PIT RD 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-1999-0493 $59.00 GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size: 7012 35 195 001 1182 BURTS PIT RD SR 11543.4 Contractor: License Type: Insurance: David Fortier CSL Address: License No.: Insurance No.: 32 Laurel St 008026 City: State: Zip Code: Phone: NORTHAMPTON MA 01060 (413) 586-8965 Pro 0 ect No: Category of Work: Const. Class: Cost Estimate: JS-1999-0950 alteration-addition $24,000.00 Description of Work: CONSTRUCT 7X 21' KITCHEN ADDITION GeoTIVIS@ 1997 Des Lauriers&Associates,Inc. Signature: