36-110 (2) ;TI
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
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NORTHAMPTON, MASS. iq Additions
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APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location e-5 r �2r-OCAC-S t �o r Lot No.
2. Owner's name JQ, Address T/?#21
3. Builder's name 71 Address
Mass.Construction Supervisor's License No. 141 "CO Expiration Date
4. Addition
5. Alteration (`G KS 00 1 "y e-i`°" (f40 11 ew cl'c
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
knowledge and bell f.
i
Signature of responsible app,icant
Remarks
mmw
�.,._ -
JUL 271,9,% asaxcflasras
xfl td 1 DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFM' AVIT
(Li censerlpertnittee)
with a principal place of business/resid`ence at:
>YA0C.,(G Sl
(str�6ty/StatrJ2p)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following v,,orker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Date)
( ) I am sole pgeneral contractor or homeowner (circle one) and have hired
the contr ors who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Ntunbcr) (Expiration Date)
(Name of Contractor) (Insurance CompanyiPoiicy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additioo2l shit if nxx=ary to iodlx5e infoe .c pertaining to au mtractom)
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 wbila homcowncra who employ persom to do coQstruction or repair work on a dwelling of
not more than throe units in which the homeowner resides or oo tbo groins appurtcawt tba-do are Dot gcoavily coondered to be
employers under the vmrkcts c=pcm4ca Act(GL152.,ss 1(5)�aMticatioa by a homeowner far a licrnse or permit may evidence the
legsi stator of an employor under the Wcrkees Compomation AcL
I uadastaad that a copy of this cratcmcat may bo fotwwdod to UK Do�of ladustri el A=d=&Offioo of Iasuranca for thn
covcsxgo vaificafion and that failure to&roue covaago undo section 25A of MOIL 152 can lead to tbo imposi -of criminal penalties
combemg of a E=of up to S1,500.00 and/or imprisoamca of up to one year and civil pcmitics in the form of a Stop Work Ordcr and a
fim of S 100.00 a day against me.
Signed this _ day of ✓��' > 1998 For dcputmr�al u� Y ✓
Permit Number
Map# Lot#
ignature of crmittee
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.
This column to be filled in
by the Building Department
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:
vo1-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge
_1
DBE: 7 APPLICANT's SIGNATURE
NOTE: Inodumnoe of a zoning permit does not reli e a ppiioanY urden to comply witlf,all-
zoning requirements and obtain all required pe from the Board of Health, Conservation
Commission, Department of Publio Works and other appliomble permit granting authorities.:;:-
r FILE #
F '` JUL 2 7
File No. 9�'/� 1
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: d
Address: ' t�a JJ Ago C X S f te.e-r-15 _Telephone: 7
2. Owner of Property: A LC-I,ar--[r
Address: - ?j %4'3/'00A-..S t (�.0 Ci Telephone: 0- �f�f
3. Status of Applicant: Owner Contract Purchaser _Lessee
Other(explain):
4. Job Location: C 21-0 jc_9f(4 e'_ Co-
Parcel Id: Zoning Map# 26 Parcel# District(s):���..
(TO BE FILLE D IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property AoV 5,—k, L
6. Description of Proposed Use/Work/Project/Occupabon: (Use additional sheets if necessary):
xL
AX& -
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 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)
Reference No: BP-1999-0113
Department: ...................................
Building, Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Roofing REC-1999-000189
.........................................................................................
......................................
Paid By: Paid in Full On:
John Corbett Mon Jul 27,1998
............... .........................................................................
......................................
Received By: Check No:
Linda Lapointe 1136
.........................................................................................
......................................
DEPARTMENT'S COPY Amount: $20.00
...........................
DEPARTMENT FILE. COPY 231 BROOKSIDE CIR
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:
27 Jul, 1998 BP-1999-0113 $20.00
GIS 9: MM Block: Lot: Address: Zoning: Use Group: Lot Size:
7191 36 110 001 231 BROOKSIDE CIR URA 19776.24
Contractor: License Type: Insurance:
John Corbett HIC
Address: License No.: Insurance No.:
56 Dimock St 10400
Li!n State: Zip Code: Phone:
LEEDS MA 01053 (413) 584-5807
Pro 6ect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0155 roofing $4,900.00
Description of Work:
REPLACEMENT WINDOWS & ROOF OVER I LAYER
GeoTIVISS 1997 Des Lauriers&Associates,Inc. Signature: