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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
:r NORTHAMPTON, MASS. J8/0- 19 4G� Additions
�, Repair
�-} ;%� APPLICATION FOR PERMIT TO ALTER
Garage
1. Location ,'i 1 (7..04&? ..5/1-1/P-4 e Lot No.
?c 2. Owner's name / /711 2/z711.– Address ,c,'?Yyi,,
3. Builder's name ify ,'Lt.,ekioi"7 Address 69 7 a, -- E \'PCP,
Mass.Construction Stipervisor's License No. C'b`/ 6 70 Expiration Date Ll 4/ `
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_ 5)))):1j 5- x2' / I-4} ''i,+'?.
13. Siding house /
14. Estimated cost- 7,1 c,,c>
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
,. :
—
Signature of responsible applicant
7 1
Remarks
� ..��.., ;;1g DEC 8 NDrx'th mPten 1
$:3 `t"IV!' jillatssxchnsctts ----_—=2.11/1=—=4---:v
i DEPARTMENT OF BUILDING INSPECTIONS t
212 Main Street • Municipal Building ---=
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
_4v_jz
fir r
(licensee/permittee)
with a principal place of business/residence at:
12 ej 7 l'`) . 1 - ,� ci (phone#) 576 —/0'9'3
(street/city/state/zip)
do hereby certify, under the pains and penalties of perjury, that:
Z I am an employer providing the following worker's compensation coverage for my
employees working on this job:
4"1'?-- ' fr2i1) ,-0 al1JL� tuCt/Ctl 02 S3� !
(Insurance Company) ! (Policy Number) •' •lion Date)
( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired
the contractors listed below who have the following workers 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 coati-actors)
( ) 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 maintenance,construction or repair work on a dwelling of
not more than three units in which the homeowner resides or on the grounds appurtenant thereto are not generally considered to be
employers under the worker's ration 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 thus'statement may be forwarded to the Deportment of Industrial Accidents'Offioe of Insurance for the
coverage verification and that failure to secure coverage under section 25A of MGL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to$1,500.00 and/or imprisoranctat of up to one year and civil penalties in the form of a Stop Work Order and a
fine of$100.00 a day against tee.
Signed this f__ day of 72c , 1990 For departrusdal use only
l / Permit Number
maro} Lot#
Signature _Licensee/Permittce ,
10. Do any signs exist on the property? YES NO
IF YES,describe size,type and location: a t t � vK I
•
0.2) )
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 column to be filled in
by the ?Wilding 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:
.(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: Issu-noes of a zoning permit does not relieve an ap ioant's burden to oomply
zoning req ire ants and obtain all required PIY , h tali
q permits from t a Board of Health, Conservtation
Commission, Department of Public) Works and other appli bie
permit granting authorities.
FILE #
DECD 8 4.. 98
File No.
r >
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: rzJ j c ircc' t W H^a tkJ
Address: A y 7 J/�' i A • Telephone: 6 —dot 't oV
2. Owner of Property: -/ u u I /1 b z►'z 4:—P
Address: 57 awt? Telephone:
3. Status of Applicant: XOwner Contract Purchaser Lessee
Other(explain):
4. Job Location: Z % t�1 h
Parcel Id: Zoning Map# Parcel# ) ' District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)Pt'5. Existing Use of Structure/Property 5. 6 2 ✓V71 b)“..)›. h
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
43 U� ? d/eY
/ IL4y Ste- c 72 )47% 1'` t N�f�`�� /�� Cr, 4S In
/ r `
h
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 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)
59 CONZ ST BP-1999-0562
GIS#: 6594 COMMONWEALTH OF MASSACHUSETTS
Map: CITY OF NORTHAMPTON
B lock: 113 113
Lot: 001
C
ategoo ry:
[Permit: Building
Category: BUILDING PERMIT
Permit# BP-1999-0562
1Project# JS-1999-1061
Est. Cost: ($3,000.00
Fee: $20.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Cyrus Newman CSL-064690
Lot Size(sq.ft.): 12893.76 Owner: HEBERT PAUL E
Zoning: URC Applicant: Cyrus Newman
(Units Gained:
AT: 59 CONZ ST
Units Lost:
ISSUED ON: 08-Dec-1998 EXPIRES ON: 08-Jun-1999
TO PERFORM THE FOLLOWING WORK:
SHINGLE OVER EXISTING 1 LAYER
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:
Fireplace/Chimney:
Gas Fire Department Board of Health
Insulation:
Rough: Oil:
Final:
Final: Smoke:
Treasury:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Roofing REC-1999-001548 08-Dec-98 1523 $20.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272
GeoTMS a 1998 Des Lauriers&Associates,Inc.