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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
a rNORTHAMPTON, MASS. t! 19 ,F Additions
APPLICATION FOR PERMIT TO ALTER Repair
f Garage
1. Location I 14U S<//V L14 6t&, Lot No.
2. Owner's name d/14 14 ay/y R �tL.Q L L i✓ Address i!?S &5?1-v C r c L it
3. Builder's name 04 lJ 1 7 4�4)4_i rr=rz Address t q o P_('i L
Mass.Construction Supervisor's License No. 4o 5"0 Expiration Date -3
4. Addition
5. Alteration 4) F L(J w JIV 00 w
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 /1 (O 64 S
13. Siding house
14. Estimated cost:-�P J/
qoUo. aG
The undersigned certifies that the above statcmcnts are we to the best of his,
knowledge and belief.
04 Signature of responsible app icant
Remarks
p4�t�pTO
V Ulasaachasctts
NOW 3 O DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building '
DEPT OF P':' .
__.i Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
L a U, �-O ,t
(licenserJpermittee)
with a principal place of business/residence at:
(phone#)
(st1eet/city/sta&2jp)
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 worlang 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 additioml shoo ifnecenuy to io�information pertaining to an cootsnctors)
01�1 am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE-picaae be aware that whilo homeowners who employ persona to do maia�camiruction or repair work on a dweniag of
not mote than three units in which the homeowner residca or on the gtounris apptuteaant thereto are not generally eoonderod to be
employes under the vmd="s compeass4on Act(GL152 fs 1(5) application by a homeowner for a license or permit may evidence the
legal stator of an employer under the Woricaes Compemation Art
I understand that a copy of this uatemmt may be forwarded to the Deputmcat of Industrisl Aaadca&Offioe of 1nomaaoe for the
ooverage verification and that failure to acatre covetago under section 25A of MGL 152 can lead to the imposition of criminal penalties
ooasisting of a foe of up to S1.500.00 and/or i apris�of up to one year and civil penatdcs is the form of a Stop Work order and a
fins of 5100.00 a day against ma
For dgmtmbww uer octly
Permit Number
!/
/3") M-0 Lot#
Signadtre of Liccnsee/Permittee
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 —2u= to be filled '
by the Building rkepartment
Required
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 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 to the best of my w1ed
DATE: 3 Lin APPLICANT's SIGNATURE
NOTE: lasuminols of 6 zoning permit does not relieve an 443plicanro burden to oompty wit" all
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission. Department of Publio Works and other appiionble permit granting authorities.
FILE #
1 is
10V 3 a 19% z
Fi 1 e No. 3 PAO
DEPT,OF 8lfl°r,{S ;1^fcpFCTi F
__ZONING PERMI T APPLICATION (§10 . 2)
PLEASE TYPE OR PRSNT ALL INFORMATION
1. Name of Applicant: ku 1 � I'S6 1 _
Address: �i� L,A U26 ( S _Telephone:�3S'(,
2. Owner of Property:
Address: G A U S T 1`y t 2 CL& Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): Con l Rtt GT062
4. Job Location: It C A0 S-C /-V !/LCl, i? .
Parcel Id: Zoning Map# 01 Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property sal N 6 LI� L/)j1'?it, y
6. Description of Proposed UseMlork/Project/Occupation: (Use additional sheets if necessary):
S T/2 tP d L.0 vv r- 14,v 0 43 gDvic
C`OZ !�L�9C/� Si [ / 1CTL)kc, lti //L. 0LV
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)
�a.t�Y hw
ly.
r
118 AUS'PIN CIR BP-2000-0542
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29-341 CITY OF NORTHAMPTON
Lot: -001
Permit:' Building
Categor :oQ BUILDING PERMIT
Permit# BP-2000-0542
Project# JS-2000-0943
Est.Cost: $4000.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO
Const.Class: Contractor: License:
Use Group_ David Fortier 103999
Lot Size(sd.ft.): 1 2501 .72 Owner: BERLIN MARIANNE YSNER
Zoning:U Applicant. David Fortier
AT. 118 AUSTIN CIR
Applicant Address: Phone: Insurance:
32 Laurel St (413) 586-8965
NORTHAMPTON 01060 ISSUED ON:11130199 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF & REPLACE PICTURE
WINDOW
POST THIS CARD S'O 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 Tyne: Receipt No: Date Paid: Check No: Amount:
Building 11/30/99 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo