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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. — -S-0 19-1-sr Additions
a APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location 1111 In Lot No.
`e-c5
2. Owner's name �es�sr� C-�G�-1 e�-�� Address Al u,.�..�; �'�-,� fc� A, Al
3. Builder's name M~ k va-FX Address 't\ 2--5wvk t+�� t? VIc11 nn f '�' �o
Mass.Construction Supervisor's License No. [?SQL j l�i Expiration Date 1� 111 �O
4. Addition (�
5. Alteration \.hc
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:- `rj 0o 0
The undersigned certifie that the above s tements are true to the best of his, her
knowledge and lief.
Signature of respons, !e app icant
Remarks
s . 1
Gxt� of Wart4ampten
B DEC �aSa aC�ttStttS
t
m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, 4PA-v,,41 1c
(licenseelpermiue�l
with a principal place iofbusiness/residence alt:
�\ 2��� e1�•�•l��e �cQ -j{ -tc OW-13(phone.#)
(stmet/city/statd2i p)
do hereby certify, under the pains and pr-nalties of perjury, that:
( I am as employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Daze)
( ) 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/Poticy Numbcr) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (E)cpiration Date)
(Name of Contractor) (Insurance Comparry/Policy umber) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach addi$oml shed ifnoccssuy to include information pertaining to all ooah-*ztors)
( ) 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 wb ilo homeownsa who employ persons to do -,I==cc,=strudioa or repair work on a dwelLng of
not morn than throe units is which the homoowricr rtsides or on the groands appurtenant thereto Are not 8-111y ooandacd to be
emiployto under the worker's coaVenstuoix Act(GL152,ss l(5))�application by a homeowner fora liaise or permd may cvidcaoe the
legal status of as employer under tho Workeea Compomation Act
I understand that a copy of this statement may he forwarded to the Deparmsoad Axad—&015*-of Imu+Anoe for the
coverage verification sad that failure to seine oov=p under suction 25A of MOL 152 as lead to the imposition of criminal Penalties
ooqusting of a fine of up to 51,500.00=Ncr ia>Prinoamatt of tip to one year and civil pcn&Wcs in the form of a Stop Work order sad a
funs of x100.00 a day against the
For depatmrw use ody
Permit Number
late
y
Signature of LicenseelPermittec
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
IF YES,describe size,type and location:
11 . ALL INFORMATION MAST 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 - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking\
## of -Parking Spaces
ht of Loading Docks
Fill:
(volume -& location)
13 . Certification: I hereby certify that the informatio cont 'ned herein
is true and accurate to the best of my knowledg .
DATE: APPLICANT's SIGNATURE
NOTE: Issuanoe of a zoning permit does not relieve an appiioant's burden to oomply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appiioable permit granting authorities.
FILE #
DEC 1
Iy
File No.
w
ZONING PERMIT APPLICATION (§I0 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: Vy\\A A- c �,Arctr�F�
Address: �6\ Q„-��-���v lt�c S te- Telephone: : CA
2. Owner of Property:
Address: �� .A....�'S Cc�.�1 Telephone: ��}
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# Parcel# District(s):, j
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property ley5%Ao(-""c°-P
6. Description of Propose Use/Work/Project/Occupation: Use additional sheets if necessary):
u L
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.
& Has a Special Permit/Vahance/Finding ever been issued for/on the site?
NO DON'T KNOlA'_____,� __ 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? NOX'_ 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-1999-0542
Department: ..................................
Building, Electrical & Mechanical Permits
........... .............................................................................
Fee Type: Receipt No:
replacement windows REC-1999-001485
... .....................................................................................
Paid By: Pa.id.in Pull On:
M....ar...k.Sarafin.............................................................. Tue Dec 01 1998
... ............
.....................................
Received By: C h eck No:
Linda Lapointe 2618
.........................................................................................
...................••....•....••.•....
DEPARTMENT'S COPY Amount- 540.00
............
DEPARTMF.NTFILE COPY 30 ALAMO CT
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:
01 Dec, 1998 BP-1999-0542 $40.00
GIS Ma Block: Lot: Address: Zoning: Use Group: Lot Size:
4853 30 ALAMO CT URA 39900.96
Contracto License Type: Insurance:
Mark Sarafin HIC Workers Compensation
Address: License No.: Insurance No.:
81 Russellville Road 104765 SAWC915695
City: State: Zip Code: Phone:
SOUTHAMPTON MA 01073 (413) 527-7812
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-1030 windows replaced $1,500.00
Description of Work:
INSTALL 3 REPLACEMENT WINDOWS
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: