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17A-078 (2) i V. ' o ro c m `o 3 0 0 rA co 0 c M o a Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations 7 Additions NORTHAMPTON, MASS.—// b) 1 ]9 APPLICa ATION FOR PERMIT TO ALTER Repair Garage 1. Location s,�? ( C_�A� S�J ' G�r�� Lot No. 2. Owner's name c - , `i1.' t etd Address r 3 0 r0" S4 - "C�/,�.�,c� 3. Builder's name N Address �p0 ,Dt_`x 4e Dr Mass.Construction S upg isor's License No. eolec 3 oy Expiration Date ' >e cw 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 13. Siding house 14. Estimated cost:- �� The undersigned certifies that the above statcrri s are we to the best of his, t knowledge and belief. Signature of rtsponsible appicant Remarks INSTALL NEW SBS MEMBRANE ROOF SAND FLASH AGAINST NEW DO LE WINDOW DORMER NEW DOU E ROLLING WINDOWS INSTALL NEW 3/8 PLYWOOD loxilpPORCH REPLACE EX115TIlNG PORCH WINDOWS OVER EXISTING DECKING WITHI SINGLE GLAZED OWNER TO PROVIDE CARPET ROLI IING WINDOWS NO RELOQATE I�XISTING D(?OR HEA AND S E S NEW TRIPLE ROLLING WINDOWS MALI NOWSKI PORCH REPAIR 0 CAROLYN ST. FLORENCE 584-0748 INSTALL NEW SBS MEMBRANE ROOF SAND FLASH AGAINST NEW DO LE WINDOW DORMER NEW DOU E ROLLING WINDOW 0 . INSTALL NEW 3/8 PLYWOOD 10 X 1 11P PORCH REPLACE EXIS�TI�NG PORCH WINDOWS OVER EXISTING DECKING WITHI SINGLE GLAZED OWNER TO PROVIDE CARPET ROL��ING WINDOWS NO HEA RELOgATE EXISTING D OR ANDS E S NEW TRIPLE ROLLING WINDOWS MALI NOWSKI PORCH REPAIR 30 CAROLYN ST. FLORENCE 584-0748 OR P ' 3 Crzt�t -of 'Wart 4ainptoll 9 B • Cy\t,�`�S��{�;'°,L �tSi AChli8Cll5 DEPARTMENT OF BUILDING INSPECTIONS w 212 Main Street • Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATTON INSURANCE AFFIDAVIT I, Nelson A. Shifflett / Valley Home Improvement, Inc. (lioall-wJpermittm) with a principal place of business/residence at: 320 Riverside nrive, Northampton, MA 01060 (phone#) (413) 584-752.2 (stn--t/ci ty/stab/gip) do hereby certify, under the pains and penalties of perjury, that: n I am an employer providing the following workers compensation coverage for my employees woricing on this job: Travelers Insurance Co. UB888D9983 2/1/00 (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: (Name of Contractor) (Insurance Company/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 additionsl shod if neoenary to include information pertaining to all coairadon) ( ) 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 persons to do u_makdenao,comtrvetioo or repair work on a dwelling of not more than throe units in which the homeowner resider or on the grounds zppurtenant thereto are oot generally eonsukred to be employers under the workcr`a oon lion Act(GL152,m 1(5)�appticalion by a homeowner for a license or permit may evidence the legal status of an employer uodar the Workeeg Compensation Ad. I understand that a copy of this rsatcmcat may ba forwwded to the Depwu cud of Industrial Axidan&Offioe of Irtavaooa for the coverage verification and that failure to secure coverage under section 25A of MOL 152 can lead to the imposition of aiminat Peaaltics oomisting of a fine of up to S 1,500.00 and/or in7prisoocat of up to one year and eivi!patties in the form of a Stop Work Order and a firm of S 100.00 a day against tae Signed this__[_ _day of 1999 F., —'" Permit Number r//rr�. Map# Lot# SiPat ure of Li stmt ttx 10. Do any signs exist on the property? YES NO s 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 1u= to be filled in by the E+nilding La &,tment Required Existing Proposed By Zoning Lot size I Frontage , o� l.t ' Setbacks - frnnt - side L: R: L: R: - rear Building height Bldg Square footage %Open Space: (Lot area minus bldg &paned parkingi # of Parking Spaces # '6f Loading Docks Fill: -(volume -& location) 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. DATE: APPLICANT'S SIGNATURE /�- NOTE: ssuanoe of as zoning permit does not relieve an applioanr urden to oomply with'411l zoning r"ulrementa and obtain all required permits from the Bo rd of Health. Conservation Commisslon. Department of Publio Works and other applionble permit granting authorition. FILE # L DEC 3 N999 File No. DEPT OF BUILE3!f�G 1NSPECTicta:> E ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: A X L Ao-I AW A Address: 1,d9J Telephone: l7�t�`7,s0) 2. Owner of Property: + (V Address: 30 C �-�� /--/Rntt'Cl Telephone: �L)"' 07y 3. Status of Applicant: Owner Contract Purchaser Lessee G--Other(explain): 4. Job Location: '90. Parcel Id: Zoning Map# ///q Parcel# District(s): � - (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property �,1 i�o V Fnii `A 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 PermiWadance/Finding ever been issued for/on the site? NO 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) File#BP-2000-0567 APPLICANT/CONTACT PERSON Valley Home Improvement,Inc ADDRESS/PHONE P O Box 60627 (413)584-7522 PROPERTY LOCATION 30 CAROLYN ST MAP 17A PARCEL 078 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid .S" Tvpeof Construction: PORCH REPAIR New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 060300 3 sets of Plans/Plot Plan THE��FO'WING ACTION HAS BEEN TAKEN ON THIS APPLICATION: d as presented/based 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 Board of Health Well Water Potability Board of Health Permit from Conservation Commi le9,9 Signature of Building Official Date Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department ' of public works and other applicable permit granting authorities. r 30 CAROLYN ST BP-2000-0567 GIS#: COMMONWEALTH OF MASSACHUSETTS 4ap:Block: 17A-078 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2000-0567 Project# JS-2000-1007 Est.Cost:$4000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO Const.Class: Contractor. License: Use Group: Valley Home Improvement, Inc 060300 Lot Size(sg.ft.): 9757.44 Owner: MALINOWSKI DOROTHY R Zoning_URA Applicant: Valley Home Improvement, Inc AT: 30 CAROLYN ST Applicant Address: Phone: Insurance: P O Box 60627 . (413) 584-7522 Workers Compensation FLORENCE 01062 ISSUED ON:1217199 0:00:00 TO PERFORM THE FOLLOWING WORK.-PORCH REPAIR POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Final: Final: Rough Frame: Gas Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy signature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 12/7/99 0:00:00 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo