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Zoning
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Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
�vrl� G
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location i ( � ' �r���' r" � Lot No.
2. Owner's name Address it �' R•
3. Builder's name lvtA Address --),
Mass.Construction Supervisor's License No. H }X48 Expiration Date ► - 'c�
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
14. Estimated cost-
The undersigned certifies that the above statements are true to the best of his, her
know edge an belief.,
�lgnature of r sponsible appicant
Remarks
9 _ B �': 1 �x�sxc[Tttsctla
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass_ 01060
WORICER'S COMPENSA'T'ION INStCJRANCE + + AVIT
rc_k c v%A
(li censcc/fermi ttrc)
with a principal place of businessJresidence at:
Ic-a(Id C, rc-i e C rtsf�,a�-t Vi n, r�►(a (ptiooe#)
(stretitici ty/scat cjn p)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following wor�-erls compensation coverage for my
employees working on this job:
(Lnsi=ce Company) (Policy Number) (Expiration Date)
O 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) (Lnsufanc: Company/Poticf Number) (Expiration Date)
(Name of Contactor) (Insurance Company/Policy Number) (Expimuon Date)
(Name of Contractor) (Insurance arnpauylPoticy Numb--f) (Expi-ration pale)
(Name of Contractor) (Insurance Company/Policy Number) (E)cpiration Date)
(&U-idi additicml vhcrt ifnoc f to ix}udc info mitioo pct inin&well occ�adon)
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 awa.•c that vettilo bor, w wbo ,ploy puTQ,w to do xjujc •„r{ vctiofl:or repair work on a d,—Uing of
not Moro than tbtoo units is trlvch t1x hoq�oovracr rcxides o oo tho pounds appusteaani js rdo etc got fatly 000sidacd to be
employes under tho-ticket",-t ica Act(GLl52,n 1(5)),appdcz600 by a homcownir for a 60=1c a Parma may cvidcme tbx
IcIpI rtxbu of an omployor under d Wk e,Coop .iioa Ad
I trndmtand that a Dopy of tbu m2 emmi may bo foewardod to tbo Depacmaco2 of I�Ttri el Axed pjfioo of Inwraoco for the
covcsrgc vuifiealioo and that U=to tccurc covemp under soc rioa 25A of MdL 152 ,lead w tbd impas—oC aiminA P-16-
ooaaisang of xlax bCuP to S 1 00.00 tca&oe impriTOamcut of up to,ooc ycpr end avil pemltia w the focrn oC a Stop Work Ordte.aad a >
find of Slco:00'a&y tigpinst is
oaay
ROjMit-'Number
- e-= a ref v.-'•tt��t`3
Q
10. Do any signs exist on the property? YES NO
WIL
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES NO_X_
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This cols to be filled in
by the Building Department
Required I
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
' &p?ved parking)
# of -Parking Spaces
f fof Loading Docks
Fill:
4 vol-time--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my kn ledge.
DATE: ( _ � C',�; APPLICANT'S SIGNATURE � '
NOTE: Issuance of a zoning
g permit does not relieve an applicant's en to comply.wltla,,all
zoning requirements and obtain all required permits from the Boa of Health. Cons ervation
Commission. Department of Public Works and other applicable permit granting authorities.
FILE #
��
JUN � =��
---- � File No' 36 '
�� ���� �� �� �
Z��~X=G P====~� �= P=X==TX~=" v ���� ~ ��
`
PLEASE TYPE OR PRZYT ALL 12JFORMATION
J
1. Name of Applicant:
Addnass —Telephone:
/
2. Owmmrmf�mwper�' �m/� �ocu��
Address: Fl �z \ '\ Telephone: 5796 6
3. Status mfApplicant: Owner Contract Purchaser Lessee
or(oxp|oin)- '
`
)�4. Job Location:
Parcel Id: Zoning Map# Parcel# District(s):~)
. (TO BE FILLED IN BY THE BUILDING DEPARTMENT)
" E)dsdng Use ofStructure/Property C>1"
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets ifneoemaery):
| `
7. Attached Plans: Sketch Plan Site Plan nQinaerad/8un/ayedP{anm
Answers to the following o questions may ueobtained by checking with the Building Dept nr Planning Department Files.
O. Has o Special pannit(Vahance/Finding ever been issued for/on the site?
NO DON'T KNOW YES {F YES,date issued:
IFYES: Was the permit recorded ot the Registry ofDeeds?
�
NO DON'T KNOW YE
IF YES: enter Book Page L end/or Document
g. Does the site contain a brook, body of water orwetlands? NO X DON'T KNOW YE
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs tobeobtaine Obtained— date issued:
'
(FORM CONTINUES QNOTHER SIDE)
'
FILE # 963644
I �►�
CANT/C�N�'ACT PERSON: - '`
PROPERTY LOCATION: o� �� �'yZ Vie►
MAP PARCEL: / J ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERNIIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING F01RM FULED 0111
Fee pnid
lRid1ding Permit Filled nut
D — ✓
Addition to Existing 4-t, CIL)-
Acressnry StrnrturP
O�,�ner/Orciipnnt .qtntpmentnrT.irf-nqp ;� Idol
T VOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION: <
✓✓ 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
A;PA-p6til, Approval-Bd of Health Well Water Potability-Bd Health
!P� ermit from Conservation C mission
Signature of Building as or Date
NOTE:issuance of a zoning permit does not relieve an applioant's burden to comply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applioable permit granting authcritls s.
Department: Reference No: BP-1998-0044
..................................
Building, Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Roofing REC-1998-000048
.........................................................................................
......................................
Paid By: Paid in Full On:
David Ingraham Wed Jun 10,1998
..........................................•..............................................
......................................
Received By: Check No:
Linda Lapointe 535
.........................................................................................
......................................
DEPARTMENT'S COPY Amount: $20.00
...........................
DEPARTMENT FILE COPY 1152 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: 167 7 Inspector: Trackine No.: Fee:
10 Jun, 1998 BP-1998-0044 Stanley Szewczyk 963644 $20.00
GIS#: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
7015 35 198 001 1152 BURTS PIT RD SR 11543.4
Contractor: License Type: Insurance:
David Ingraham
Address: License No.: Insurance No.:
22 Picard Circle
City: State: Zip Code: Phone:
EASTHAMPTON MA 01027
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1998-0045 $2,200.00
Description of Work:
replace front window with bay window
GeoTMS40 1997 Des Lauriers&Associates.Inc. C.....�f,.rP•