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36-131 (3) a o K � � v ro o• � W m 3 ° m Z Z 70 O > m a Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MASS. Lu 19'1'�( Additions % ' APPLIa CATION FOR PERMIT TO ALTER Repair Garage 1. Location `�©� QOny-,%co-e C C\--e Lot No. 2. Owner's name Address S v� —--� 3. Builder's name Address n6 Mass.Construction Supervisor's License No. n'S-�i Z L1 Expiration Date 4. Addition 5. Alteration_�=cP e"eeL , S- 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 Acmcnis are we to the best of his, her knowledge an i Signature of responsible app icant Remarks -e \c Ee�.-� �t ",��•� S - •�' a '. ,, 1 ��: �� ' Crit{� .Of art ant tnn ` $ 6 �� '� g, �lassacflnsctta ;',SD&ARTMENT OF BUILDING INSPECTIONS r, -'"z"`L12 Main Street Municipal Building Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT LIF 11..E (licensee/permittee) with a principal place of business/residence at: va, (phone#) <a-1—--T'k I a. (street/city/sta&2ip) do hereby certify, under the pains and penalties of perjury, that: XI am an employer providing the following worker's compensation coverage for my employees working on this job: `' a (Insurance Company) (Policy Number) (E. pi tibn Date) ( ) 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 Comparry/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Compaay/Policy Number) (Expiration Date) (Name of Contractor) (insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additieml sheet if necessary to include information pertaining to all ooatrndors) ( ) 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 while homeowners who employ peasom to do makIcamce,suction or repair work on a dwelling of not more than throe units is which the honmwoer resides or m the grounds appurtenant thereto arc not generally oonudacd to be employers under the worker's oompenu4on Act(GL152,ss 1(5))�apprication by a homeowner for a license or permit may evidence the legal stahra of an employer under the Workers Compemation Act. I understand that a copy of this statement may be forwarded to the Depw n cat of Industrial Ac &n&Offioe of Insauanoe for the coverage veriticatioa and that Endure to segue covemga under section 25A of MGL 152 can lead to the imposition of criminal penakies ooasisting of a fine of up to$1,500.00 sndlrx imluisomnwi of up to one year and civil pcnal6e s in the form of a Stop Work order and a fine of 5100.00 a day against ttte For departmental use Daly Permit Number a Lot# l!►30 r Maps Signature of LicenseelPermittee t 10. Do any signs exist on the property? YES NO IF YES,describe size,type and location: 1. 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 I 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) # _pf `Parking spaces f of Loading Docks Fill: =(vol-ume--& location) 13 . Certification: I hereby certify that the information cont 'ne herein G, is true and accurate to the best of my knowledge. D21TE: c14 APPLICANT's SIGNATURE NOTE: Issuance of a zoning permit does not relieve an applioants burden to comply wit4 'all zoning requirements and obtain all required permits from the Board of Health, Conservetion Commission, Department of Public Works and other applicable permit granting authorities. FILE # 1 JUN 3 0 1'998 File No. 2 350 i ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: Vim•,....-L Address: Telephone: jsa-1-1V'j�-a 2. Owner of Property: \-�-� --� Address: Q,��o�c<,��Q�e C" rc1-Q Telephone: S`6 La - Sa`C� 3. Status of Applicant: Owner )�contract Purchaser Lessee Other(explain): 4. Job Location: C��c\�-c Parcel Id: Zoning Map# &(k, Parcel# District(s): t O A (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property '\\"-, (- 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 KNOIN__ /� _ 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_A 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) 1 ,� �,.. FILE I 9 U 3 a 3 Q j j i JUN 3 01'998 ' _ k APPLICAN 4 T/(jONTACT PERSON:-7iY&11 �S" �d�7 �kt ;;L- 'ADD'RESSAIRR NE: 1,?Ce PROPERTY LOCATION: MAP 3 PARCEL: ZONE G� -_ THIS SECTION FOR.OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM EITIED OUT Fee Pnid lRiii1ding Permit Fillefi 011t New C'nnetrnrtinn Rem rlelinu Interior Addition tn Existing Arrectnry Ctriirtin•e _ j311i1rlin_aPlanz Tnrlyirled- — 0xvner/Orrupant Statement nr License # THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP LICATIONI Approved as presentedfbased 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-Bd of Health Well Water Potability-Bd Health !Permit from Conservation Commission Signature of Building Inspector Date NOTE:Issuance of a zoning permit does not relieve em applicant's burden to oompty with ail zoning requirements and obtain ail required permits from the Board of Health. Conservation Commission, Department of Pubiio Works and other applicable permit granting authoritle-s. Department: Reference No. BP-1998-0091 Building, Electrical & Mechanical Permits .. .. ......... - Fee Type: Receipt No: replacement windows REC-1998-000099 Paid By Paid in Full On: Mark Sarafin Tue Jun 30,1998 .---------------------------------•---•---...............------•---.............---.-•--- ...................................... Received By: Check No: Linda Lapointe 2389 ........................•---.........-----........................--•..............•..... ...................................... DEPARTMENT'S COPY Amount: $20.00 ........................... DEPARTMENT FILE COPY 303 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: 1�5t, Inspector: Tracking No.: Fee: 30 Jun, 1998 BP-1998-0091 963730 $20.00 GIS #: Mau Block: Lot: Address: Zoning Use Group: Lot Size: 7211 36 131 001 303 BROOKSIDE CIR URA 22041.36 Contractor: License Type: Insurance: Mark Sarafin HIC Workers Compensation Address: License No.: Insurance No.: 81 Russellville Road 104765 no #yet City: State: Zip Code: Phone: SOUTHAMPTON MA 01073 (413) 527-7812 Proiect No: Catesory of Work- Const. Class: Cost Estimate: JS-1998-0095 $2,400.00 Description of Work: install replacement windows GenTMS40 1997 Des Lauriers&Associates.Inc. Cianafiir•n-