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32C-113 (16)
a 2 tvl D m 70 a _ © O to © Zm O `I r S „ Z G /moo R .ti -3 C ^ e Z �• o a 1 leiT Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations T-r NORTHAMPTON, MASS. \ 'x 4 " 19 Additions c!cr'' ` ' �APPLICATION FOR PE MIT TO ALTER Repair Garage 1. Location ! tr '? kv--: Lot No. 2. Owner's name PO.)4 lit i,. (,)1--4-- Address 3. Builder's name C.tilry Y 1:1-€..u..:J ni-et-An Address 61-174- f": 0.e ,-Ct Mass.Construction Supervisor's License No. C_� 44 t A 0 Expiration&ate 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 ,'p.:t;<1f'...,r g C X`= 0 i .t5 Le r`) ? a 11' `-k .4"(6i ) L4'Y.--`O. I I 'd 13. Siding house 14. Estimated cost- The undersigned certifies that the above statements are true to the best of his, her 00 knowledge and belief. 2 1 ` ,: Signature of responsible appicant Remarks r 1 L �;�49T�'i.^ �C� i Lcx'P � f�. F ► i'rs 1 trz �= \4 5 5 S� •vim 1 9 r=04 1tAMp O4 1 1 �6.Rk-- .)1' i NOV 9 1999 i C�izt of titantptun 1 _*°� n 44 /v f low- s.�i/ �'� I? lASSa[hltSttla ===—W1111— 4,�slt i OF S� rot i A ,._ ' DEPARTMENT OF BUILDING INSPECTIONS 4 212 Main Street • Municipal Building =1V Northampton, Mass. 01060 terra WORKER'S COMPENSATION INSURANCE AFFIDAVIT I, al ruS t4 b.J.) niaA-a Oicenseelpermittee) with a principal place of business/residence at: Lo f )i l (15f f E.d. J\l Or'v(i(l itt 1•l 1Ucv (phone#) - I O° ��„ J (street/city/state/zip) do hereby certify, under the pains and penalties of perjury, that: (( I am an employer providing the following worker's compensation coverage for my employees working on this job: &fled v. Co• Aeux CI1 C-1.L �1,rt�'LC.100 (Insurance Company) (Policy Number) (Exp' lion 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 if necessary to include information pertaining to all ooatractors) ( ) 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 persona to do m*mtmaar',construction or repair work on a dwelling of not more than three units in which the homeowner resides or on the grounds appurtenant thereto art not generally considered to be employers under the worker's oompenation Act(GL152,ss 1(5)),application by a homeowner for a license or permit may evidence the legal status of an employer under the Worker's Compensation Act_ I understand that a copy of this statement may be forwarded to the Depertmennt of Industrial Accidents'Oboe of Insurance for the coverage verification and that failure to secure a coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties cousisiing of a Eine of up to S 1,500.00 and/or imprisonment of up to one year sad civil penalties in the form of a Stop Work Order and a fine of S100.00 a day against tae. Signed this ( day of AC)V , 1997 For departnratel use only I Permit Number _ y f Map#, Lot it Si es. I s . of Licensee/Permittee 10. Do any signs exist on the property? YES 'X NO IF YES,describe size,type and location: J Are there any proposed changes to or additions of signs intended for the property?YES NO>c IF YES,describe size,type and location: 11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. This coiumu to be filled in by the Building Department 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) # of Parking Spaces #- of Loading Docks Fill: {vol-ume--& location) 13 . Certification: i hereby certify that the information contained herein is true and accurate to the best of my knowledge. � DATE: /1//c/Ii/ /7v, APPLICANT'S SIGNATURE NOTE: Issuanoe of a zoning permit does not relieve an ap ioants burden to oom with zoning PIY tA all g requirements and obtain all required permits fro the Board of Health, Conservation Commission, Department of Pubiio Worics and other app oable permit granting authorities. FILE # ti =p NOV 91999 File No. - ..- _..ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: k_ Vt )j ,{\'a A Address: 074 Sr i do e 1C..(1 '. r, !f Telephone: 2. Owner of Property Li k 0 k. %j '}- � /) Address: T L Telephone: 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): ( 7_04 F+2a los Z 4. Job Location: Parcel Id: Zoning Map# 3d e_ Parcel# //3 District(s): It-1' .. (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property C ir�c `L 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): r i j Li 1`s j4 Yl1't`1,4 ""r C<- $ Lv 4 C 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 Fifes. 8. Has a Special PermitNariance/Finding ever been issued for/on the site? NO DON'T KNOW A 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) Air 59 CONZ ST BP-2000-0500 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C- 113 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:roofing BUILDING PERMIT Permit# BP-2000-0500 Project# JS-2000-0864 Est.Cost: $2500.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Cyrus Newman 064690 Lot Size(sq.ft.): 1 2893.76 Owner: HEBERT PAUL E Zoning:URC Applicant: Cyrus Newman AT: 59 CONZ ST Applicant Address: Phone: Insurance: 697 Bridge Road (413) 586-1093 Workers Compensation NORTHAMPTON 01060 ISSUED ON:11/10/99 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF 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 Sinnature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 11/10/99 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo