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All
Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
a
Garage
Location 6e 7 :Z Lot No. �p
wner s name I7/S Address
c./3. Builder's name, k.Z�i�t- Address
Mass.Construction Supervisor's License Expiration Date
4. Addition
,S. 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
x/12. Type of roof
13. Siding house
. Estimated co t
d(r(� The undersigned certifies that the above statements are we to the best of his.
✓✓ knowledge and belief.
Signature of responsible appicant
Remarks
o PTA �❑
$ mica httartta
EP TMENT OF BUILZ)rNG INSPECTIONS
+tJG SpECSr C 2 .
• ��OF`g�1tD�t� ►F,� ),C.�� sin Street Municipal Building
Northampton, Mass. 01060
WORICER'S COMPENSATION INSURANCE AFFIDAVIT
(licensee/permittee)
with a p ' cipal place of business/residence at:
ZVI &�5e (phone#)
(street/city/state/zip)
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 additional shed Tnecesssry to iwlu&inforaution pertaining to ell ooeradors)
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 while homeowners who employ pc=m to do mai*+e—__M__�� oontvction or repair work on a dwelliag of
not more than three units is which the homeowner redden or an the grounds appurtenant thereto art not gwerally considered to be
employers under the vmd='s compensation Act(GL152,s 1(5)),application by a homeowner for a lice=or permit may-idea—the
legal aatru of an employer under the Wortceea Compensation Act
I understand that a copy of this cutemeat may be forwarded to the Depnrftnoo2 of Indrnhiel A=4=&Oboe of Iamurwoe for the
coverage vc ification and that failure to smut coverage under section 25A of MGL 152 can lead to the kVositioa of criminal penalties
consisting of a fine of up to$1,500.00 and/or iaRisonmerst of up to one year and civil pemwes in the form of a Stop Worts Order and a
fine of$100.00 a day against tee.
For dep�l use only
Permit Number
Map# Lei#
grab=of Licensee/Permittee
�-x
10. Do any signs ebst on the property? YES NO C�
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 oolsmm to be Pilled ;ti
by the Banding 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
&Pai,ed Parking)
# 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�too the best of my knowledge.
l
DATE: �l b 2- APPLICANT's SIGNATURE
NOTE: Issuanoe of a z Wing permit does not relieve an plioanYs burden to oompty wRla-all
zoning requirements and obtain all required permits f m the Board of Health, Conservation
Commission, Department of Publio Works and other a lioable permit granting authorities.
FILE #
41.
10112 4
File No.
DEPT Of BUILDIrNC,114SPECT10 =
'?NIRG PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1 Name of Applicant:
Address: Telephone:
Owner of Property:
Address: Telephone:
�. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):/
4. Job Location: �??
Parcel Id: Zoning Map# .2 1 PParcel,, C/O District(s): `� S
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property_ STZ�l
6. Description of Proposed U or roject/Occupaton: (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 D cument#
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)
677 BURTS PIT RD BP-2000-0541
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29-476 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:roofing BUILDING PERMIT
Permit# BP-2000-0541
Project# JS-2000-0939
Est. Cost: $3000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: James Roberts 117154
Lot Size(sa. ft.): 300564.00 Owner: BRIN JOSEPH V&PATRICIA C
Zoning SR Applicant: James Roberts
AT. 677 BURTS PIT RD
Applicant Address: Phone: Insurance:
30 Edwards Rd (413) 527-6078
WESTHAMPTON 01027 ISSUED ON.11/24/99 0:00:00
TO PERFORM THE FOLLOWING WORK:STR I P & S H I N G LE ROO F
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 11/24/99 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo