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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
1 r
Garage
1. Location CA� dA u e-Q" CV O/c/�L Lot No.
2. Owner's name A I"rf4-r-A _ t!5�te�_4—o'A-/ Address A
3. Builder's name � V�,e,� �V S el 1 Address--S-6 4,Ac" - s! L--
Mass.Construction Supervisor's License No. 1 (fl_- !0 V vo a Expiration Date ;_:�ZOAO
4. Addition
5. Alteration /V ctJ L//K- L Sr �► rLc;,
6. New Porch
7. Is existing building to be demolished?
S. 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 belief.
Signature of responsible app,icant
Remarks
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<s� DEPARTMENT OF BUILDDZG INSPECTIONS
212 Main Street ' Municipal Building 'o
Northampton, Mass. 01060
WORKER'S COMTENSATION INSURANCE AFFIDAVIT
(licensee/permittee}
with a principal place of business/residence at:
G«sue
�j Wt-c c S/ _(phone#)
(street/city/stalri a p)
do hereby certify, under the pains and penalties of perjury, thai:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insu=ce 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 workers compensation policies:
(Name of Contractor) (Insurance Cornpa-uy/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy/PoLicy Number) (Expiration Date)
(Name of Contractor) (I:.sz ran Comr,any/roky Nrr;?i,r-) (Expi,ation Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(nand'a6di6ocn1 xboe if necessary to include infot oa pertaining to all omb-. ors)
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 whilo homeowncn who employ pazom to do=iMMMCC conduction or rrpair work on a dwelling of
not mece than three units in which the bomoowner reside=or oa the geunds appurtcaaut tba-do are not gcna slly oonsidcred to be
cmploycrs under the work&%oempe=saticn Act(GL152,ss 1(5)�application by a hom,eowncs for a license a pazna may evidenoe the
legal ciania of au omployec under the Workcez Compemation Ad.
I undcnt d that a oopy of this ctatcmcat may be forwerdod to tbo Dcpa�of Industrial Arade Ofhoo of Iauuanoo for the
cova-xg vaificatioa and that failure to saztre covcnTo under scdion 25A of MOL 152 can Iced to the imposition of criminal penalties
coosi.sting of a fine of up to S1,500.00 an&or hnpriso�of up to one year and civil pcmltics in the form of a Stop Work Orda and a
fins o(5100.00 a day agtinst me.
Signed this _�T day of� =-f— , 1991 Ford, t e only
Permit Number
Map;{ Lot#
Sign�bmo l=se Pc ittce
e w
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 cols 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
&p?ved parking)
f �Parking Spaces
of Loading Docks
Fill:
(vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
_1
is true and accurate to the best of my knowledge.
APPLICANT's SIGNATURE
?" NOTE: Issruanoe of at zoning permit does not relieve ioant' urden to oom wlt
PP P1Y h,..all-,
zoning requlrements and obtain all required perm) from the Board of Health, Conservation
Commission, Department of Publio Works and other applionble permit granting authorities:..
=!; FILE #
t AUG 2 4 11998
`
d35
File No.
°` C71 'ING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: S G A a&&C.,I.e- 37j Telephone: 7
2. Owner of Property: 9t C—N a-z--ci—
Address: c.?j `3 B n Telephoner S�
3. Status of Applicant: Owner Contract Purchaser"_Lessee
Other(explain):
4. Job Location: / Q ft e-r— LuC�C�C
Parcel Id: Zoning Map# _ Parcel# a- District(s):
(TO BE FILLED IN BY TH B//UILDING DEPARTMENT)
5. Existing Use of Structure/Property 17/6I41/5 t~_�ttr�
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
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 KNOT:� 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)
opt
Department: Reference No: BP-1999-0235
Building, I lectrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Vinyl siding
5 REC-1999-00051.3
.........................................................................................
Paid By:
John Corb6t "P"a*i"d—in I-61�
......................................................................................... Wed Aug 26,1998
.. . ...... •......
Received By: .C.h.eck.No:...................
Linda Lapointe 1153
.......... ............ ...
......................................
DEPARTMENT'S COPY Amount. $20.00
..............---.......•..
DEP ARTMENTFILE COPY 113 BRIERWOOD DR
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:
26 Aug, 1998 BP-1999-0235 $20.00
GIS Mai) Block: Lot: Address: Zoning: Use Group: Lot Size:
4908 29 184 001 113 BRIERWOOD DR URA 10628.64
Contractor: License Type: Insurance:
John Corbett HIC
Address: License No.: Insurance No.:
56 Dimock St 10400
City: State: Zip Code: Phone:
LEEDS MA 01053 (413) 584-5807
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0439 vinyl siding $5,000,00
Description of Work:
INSTALL VINYL SIDING
GeoTIVISS 1997 Des Lauriers&Associates,Inc. Signature: