17C-135 (11) a
z
'9 0
�.r3 c n•
co a+
- ap m
Z m
a� �I •••1 O R � .� p
5 C;
70 Z
O
Z v
o
a
Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. ""56- Additions
40
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location Lot No.
2. Owner's name \UN(yeU.e C �-� C C� - Address to 2��.,
3. Builder's name VV\ 4 -S ,,—vz Address `6\ S t
Mass.Construction Supervisor's License No. Q)5?:�!:1 L{ Expiration Date �r
4. Addition
5. Alteration
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 yy\-4 NSA tit Q G et Pt C,--, 'a 1,tl Pe�A 'a Ll .C-
13.13. Siding house
14. Estimated cost- 5 �Slb C
The undersigned certif' s tha a abo statements are we to the best of his, her
knowledge an lie
Signature of r V11sible appicant
Remarks
SEP81998 assxrflrrsrtte
m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S COITENSATION INSURANCE ' AVTT
(li ct;Ii seek permi rice}
with a principal place of business residence at:
V"O- (phone#) 5'PI-7 -7 -a
(st-ce_Ucity/statdzi )
P 6�a 3
do hereby certify, under the pains and penalties of perjury,
(X I am an employer providing the following workers compensation coverage for my
employees working on this job:
(Insurance 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 worker's compensation policies:
(Na-me of Contractor) (Insurance CompanylPolicY Number) (Expiration Date)
(Name of Contractor) (Insurance Coinpauy/Pohcc,r Number) (Expiranon Date)
(Name of Contactor) (Insurance Company/Policy Number) (Exp�rabon Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(auar_h additional slo=t Lf ineccz to Mciude mfbmliiion peztftlaing to all codr f3)
( ) 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 whUo homeowners who cmplay perioas to do main ,^n mnstu oa or repair work cn a dwelling of
not more than three units in which the honxowncr r=dcs or on the grounds appurtensnt thczc art:net fi m
lly asidcrcd to be
employee under the worker`s.00mpcmation Act(GL152,ss 1(5)),application by a homeowner for a liaase or permit may evidence the
legal st b, of an employer under the Workces Compensation AcL
I ua krA=d alai a copy of this statcmcat may be forwn d-d to the Depart, c of Indzut i al A,-ddm&Ofiioo of Iawnooe for the
oov=ge verification and that failure to scatre coven under sociiou 25A of MGL 152 can lcsd to the imposition of-bnh l pcn W-
000sisiing of a f ac of up to S1,500.00 and/or imprison of tip to one year and civil pemltia is the form of a Stop Work Or+dcr and a
film of S100.00 a day tpinst n-_
E pse oily
r
1- Lot#
Signature of Liconscr1Permitice
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_X,_
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This col== to be filled in
by the Banding nepartment
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 parkingi
# of Parking spaces
f of Loading Docks
Fill:
{vo1-ume--& location)
13 . Certification: I hereby certify that the information cont 'ne herein
is true and accurate to the best of my knowled
DATE: Q( -`�C{ APPLICANT's SIGNATURE t
NOTE: Issuance of a zoning permit does not relieve an applioant's burden to oom wit y
zoning requirements and obtain all required plY , h1 •io
q permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applicable permit granting authorities.
FILE #
k 11
SEI`l 8 1 @98
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: V v V 4:�\A V2WC--\,L._
Address: `{6\ �.� 5 ��O r�� e ^ � Telephone: -7
2. Owner of Property: 'k- 10 .Af f Q_�\"Z_ } CO
Address: I LQ ( � � ') �— Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# Parcel# L District(s): J
(TOD IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property e-<'
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/Vadance/Finding ever been issued for/on the site?
NO DON'T KNOItij__2�__ 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)
Reference No: BP-1999-0282
Department: ...............•...........•.......
Building, Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Roofing REC-1999-000686
P 'P'a'id...i*n*...Full...0...n':..........
....Mark.Sarafi..n.............................................................. Tue Sep 08,1998
.......... .......... .
.. . ...... ......
Received By: .Check. . .No:...................
Linda Lapointe 2491
.........................................................................................
......................................
DEPARTMENT'S COPY Amount: $40.00
........... .........
DEPARTMENT F1LE COPY 16 BARDWELL ST
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:
08 Sep, 1998 BP-1999-0282 $40.00
GIS #: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
8834 17C 135 001 16 BARDWELL ST Sl 56192.4
Contractor: License Type: Insurance:
Mark Sarafin HIC Workers Compensation
Address: License No.: Insurance No.:
81 Russellville Road 104765 SAWC915695
Li!xi State: Zip Code: Phone:
SOUTHAMPTON MA 01073 (413) 527-7812
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0599 roofing $4,500.00
Description of Work:
INSTALL METAL ROOF ON STORAGE BLDG
GeoTIVISOD 1997 Des Lauriers&Associates,Inc. Signature: