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3 01999
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ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 47 C'
Address: — .5
�°� 9R on LSi'de, Telephone: '553�y e'16
2. Owner of Property:
Address: `'ice & ai c,'-'ae Telephone: �jOE
3. Status of Applicant: _j -wner Contract Purchaser Lessee
Other(explain):
4. Job Location: (::�?-S5—
Parcel Id: Zoning Map# �-16,_ Parcel# Jd,5' _ District(s): -,eZ
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed UseMlork/Project/Occupation: (Us/e additional sheets if necessary):
r r
7. Attached Plans: _v,-' 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_ f� YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOWS 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)
10. Do any signs exist on the property? YES V NO
IF YES,describe size,type and location: S SS 6 Lu W 4P
h u f�u\ ce n;c� 1S ��� JCs iC�e CF c
Are there any proposed changes to or additions of signs intended for the property?YES
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This —?== to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
r
Frontage
Setbacks
- side L: R: 5o L: YS _R: )
- rear
Building height
Bldg Square footage �sQ >� - ��
%Open Space:
(Lot area minus bldg q 0/ p �1d
&paved parking)
.of _Parking Spaces
f of Loading Docks
Fill:
vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
D71 E: _ q V APPLICANT's SIGNATURE ? �G
NOTE: ssuanoa of at zoni permit does not relieve an a a
9 P pplioant's burden to mply witl�,,�pll-
zoning requirements and obtain all required permits from the Board of Health, Conservtmtion
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 60V Z Alterations
NORTHAMPTON, MASS. 19 Additions
Repair '0
• APPLICATION FOR PERMIT TO ALTER
Garage
1. Location koo kS iC 4 F 1 CI 6'1V C-C Lot No.
2. Owner's name A J W ,Al C, e i t 11 IU &_ Address 4�R S-S A,46,2�S IA&
3. Builder's name C),Lk) ?k Address SQ YA e-
Mass.Construction Supervisor's License No. Expiration Date
4. Addition ra im A C %on 6 C'
5. Alteration
6. New Porch C
7. Is existing building to be demolished?
8. Repair after the fire r
9. Garage- add 414;- 1) t-j4 No.of cars Size X30 X�3
10. Method of heating c
11. Distance to lot lines -/s !i. 1 Fpw
12. Type of roof �S' h i+ W n ), --
13. Siding house
14. Estimated cost:- C or" oo
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of respo ble appicant
Remarks
(rzt� of 'Wart4alliptoll s
e 3 ? r; �ASbA[IjU8tt15
3 O DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR Main Street ' Municipal Building
M yv•
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
n� (Please Print)
DATE: /I I a OQCA tt) 1 Q q GT
JOB LOCATION:
(Map) (Parcel) (Subdivision)
HOMEOWNER: C da kh V_o .mom ,' � //f �rJ/ /N�1Us?TN
Ma e & Address ) L
% 1_��1-6 46:2,
(Home Phone) (Work Phone)
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one ( 1 )or two (2) families. and to allow such
homeowner to engage an individual for hire who does not possess a `
license, provided that the owner acts as supervisor. CMR780 Section 109. 1 . 1
DEFINITION OF HOMEOWNER: Person(s ) who own a parcel of land on
which he/she resides or intends to reside, on which there is, or is
intended to be, a one or two family dwelling, attached or detached
structures accessory to such use and/or farm structures . A person who
constructs more than one home in a two-year period shall not be
considered a homeowner. Such "homeowner" shall submit to the Building
Official, on a form acceptable to the Building Official, that he/she
shall be responsible for all such work performed under the building
permit.
As acting Construction Supervisor your presence on the job site
will be required from time to time, during and upon completion of the
work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers '
Compensation) and Chapter 153 (Liability of Employers to Employees for
injuries not resulting in Death) of the Massachusetts General Laws
Annotated, you may be liable for person(s) you hire to perform work for
you under this permit.
The undersigned "homeowner" certifies and assumes responsibility
for compliance with the State Building Code, City of Northampton
Ordinances, State and Local Zoning Laws, and State of Massachusetts
General Laws Annotated. ��' �
HOMEOWNER SIGNATURE e:5 c"—/
BUILDING PERMIT #
oaf 'daz#ilantpfan
MR V 019-
U. r",;' •^ DEPARTMENT OF BUILDING INSPECTIONS
•�f3F b4;� ,,
=•- ......-», a 212 Main Street ' Municipal Building '
Northampton, Mass. 01060 '
'ORDER'S COMPENSATION INSURANCE A i '' AVTT
with a principal place of luwimess/residence at:
r �- ,,> (phone#)
( vcity/grip) le6
do hereby certify, under the pains and penalties of perjury, that:
O I am an employer providing the following workers compensation coverage for my
employees working on this job.
(Insurance Company) (Policy Number) (Expiration D=)
( ) 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) (Imsvrance Company/Poticy Number) (Expirntioa Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(ananh additioml sluct ifnaocnsry to include intocmitio,pcctnini"to nn ooa r,d m)
( ) I a sole proprietor and have no one working for me..
(j� a home owner performing all the work myself.
NOTE:please be awatc that wti to hcmcoAmcrs who employ pcacs to do mA i.tea kcr,omstvC.ion or repair work on a dwcUing of
not morn than thr"units is Wf ieh the homoowocr raidcs oc oa the groaads appurtecsxd thado arc oot generally oo=dcrcd to be
cwtoyas under tba was oomprnsatim Art application by a homoowncr far a Gecnx cc permit maY evidcnm the
legs(etatua of an omployr under tho Wocicoes Compemaiioa Act
I undasinnd t6,i a Dopy of this ctzt®mt may lie foca.v dod to tbo pcpartmcad of lndauhiel Attidmi�Ol�oo of[m�uiooe for 6.
cover g vaifimuoo and that failure to ecatre covaip uudcr scdion 25A of MoL 152 can tad io 60 imposition of criminal P-16-
oomi3ting of a fine of up to S1,500.00 andlor of tip to om Y=and civil pcmltics is the form of a Stop W ortc Order and a
firm oCS100.00 a day against MC.
For dep:rtca�uao only
Permit Number
Lot#
Sigaati=ofLicc;nswJPcrmi
File#BP-1999-0800
APPLICANT/CONTACT PERSON BURLINGAME EDWIN C JR&JILL P
ADDRESS/PHONE 255 BROOKSIDE CIR 584-6062
PROPERTY LOCATION 255 BROOKSIDE CIR
MAP 36 PARCEL 125 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid &IyiC1
Typeof Construction: CONSTRUCT 30 X 30 ATT GARAGE 12 X 21 FAMILY ROOM& 12 X 20 DECK
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE 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
Septic Approval Board of Health Well Water Potability Board of Health
Permit om Conservation ission
i
Signature of Building Official Date Z7 /2'
Note:Issuance of a Zoning permit does not relieve a 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.
255 BROOKSIDE CIR BP-1999-0800
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36- 125 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: alteration-addition BUILDING PERMIT
Permit# BP-1999-0800
Project# JS-1999-1433
Est.Cost: $20000.00
Fee: $215.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group:
Lot Size(sg.ft.): 16770.60 Owner: BURLINGAME EDWIN C JR&JILL P
Zoning:URA Applicant:_
AT: 255 BROOKSIDE CIR
Applicant Address: Phone: Insurance:
ISSUED ON.41611999 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 30 X 30 ATT GARAGE, 12 X 21 FAMILY
ROOM & 12 X 20 DECK
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 Sienature•
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 4/2/1999 0:00:00 $215.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo