17A-123 (5) a z
Dr7
to 3 0 Zm
� Z
> cn O
Z _
_a
A
Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.J63 -7 10 c�\ Alterations
NORTHAMPTON, MASS. 1911 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location Lot No.
2. Owner's name y,,. �alcv e- Address
3. Builder's named Address 2 3n
Mass.Construction Supervisor's License No. SS�b� Expiration Date (1 00
4. Addition
5. Alteration 60-q w i Jctv),to, '51 Z,e akkj LjU
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 c SL-
3 The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
Signature of responsible app icant
Remarks
�Ali 5 1998 � � �. z
$ e �ilTassarlprsctla
m. DEPARTMENT OF BUILDING INSPECTIONS
Y 212 Main Street ' Municipal Building
Northampton, Mass. 01060 'J
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(liaens&&permittee)
with a principal place of business/residence at:
� arw �5Y1�re / S6. (phone#) ql� ?0?
(street city/Aarrlxip)
do hereby certify, under the pains and penalties of perjury, that:
MI am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) Txpiratfoh 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 Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheet ifnecenary to include information pertaining to all contras o )
( ) 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 peacm to do mahteaaace,consmxtion or repair work on a dwelling of
not more than three units der which the homeowner resides or on the groands appurtenant thereto are not generally considered to be
employers under the work eft compensation Act(GL152,s 1(5)),application by a homeowner for a license or permit may evideme the
legal staves of an employer under the Worker's Compensation Ad
I undetstaad that a copy of this statement maybe forwarded to the Depatni o of Iukorial Accidents'Offioe of Insruaaoe for the
oovaxge verification and that failure to secure coverage under section 25A of MOIL 152 can lead to the impositioa of tximinal penalties
of a fine of up to$1,500.00 andlor imprisonment of up to one year and civil penalties is the form of a Stop Work Order and a
find of 5100.00 a day agaiwa rue.
Signed this 54� day of 191$ gPermit l l mrae only
Number Lot#
Signawre of Licensee/Permittee
10. Do any signs east 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 L
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This aolama to be filled in
by the Building Depnztment
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
&Paved parking)
# of Parking Spaces
ht of Loading Docks
Fill:
{vol-ume--& location)
13 . Certification: I hereby certify that the information cont fined herein
is true and accurate to the best of my knowled .
DATE: % s q 2$ APPLICANT's SIGNATURE
NOTE: Issuance of a zoning permit does not relieve an applicants burden to comply wit4,4kn
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applionble permit granting authorities.
FILE #
Fi 1 e No. IV Y
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: W , '. 'rte l N"ALqE)
Address: -1 S Telephone: 91 '?
2. Owner of Property:
Address: o 'C4 e Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: 3130 f I ' e
Parcel Id: Zoning Map#� - Parcel# District(s):_
(TO BE FILLED IN BY THEIBUILDING DEPARTMENT)
S. 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 A DON'T KNOW 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)
Reference No- BP-1999-0151
Department: ...................................
Building, Electrical & Mechanical Permits
........................................................................................
Fee Type: Receipt No:
replacement windows REC-1999-000304
.........................................................................................
Paid By: Pa.id..i.n•Full.•....0.n:..........
....Walter
...Wait er.Marek.&.Son................................................. Thu Aug 06 1998
........ ... ............ ... ......
.. . ...... ......
Received By: .Check. . .No:...................
Linda Lapointe 1.502
.........................................................................................
......................................
DEPARTMENT'S COPY Amount: $20.00
...........................
DEPARTMENTFILE COPY 330 BRIDGE RD
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: Trackins!No.: Fee:
06 Aug, 1998 BP-1999-0151 $20.00
GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size:
1433 17A 123 001 330 BRIDGE RD URA 9713.88
Contractor: License Type: Insurance:
Walter Marek& Son CSL Workers Compensation
Address: License No.: Insurance No.:
84 Shaw Rd 055201 83HUB904K76
City: State: Zip Code: Phone:
GOSHEN MA 01032 (413) 268-7109
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0253 windows replaced $3,000.00
Description of Work:
REPLACE BAY WINDOW
GeoTIVIS@ 1997 Des Lauriers&Associates,Inc. Signature: