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29-313 (4) .-.N 77 m cDn Z m rb ar '7 Ln Z > cn 0 tV r --3 rri Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MASS. U ti 19 L /q Additions APPLICATION FOR PERMIT TO ALTER Repair a /� Garage 1. Location ✓✓ �- � Lo[No. 2. Owner's name 5 Address ray ,A c-, 9 if i//°�g-o 6 h—' D 2 f/Id 2L�lJ� MA 3. Builder's name °� � 5 e �A) Address �S1 �� l� +� �' �y Mass.Construction Supervisor's License No. 0 13-Z 9 Expiration Date O l- 5-' - J0 O 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. Esumated cost- The undersigned certifies that the above statcments are true to the best of his, he knowledge and belief. . - d -A�11 Signaeu a of responsible app icant Remarks -it� X1 LtZ �11Y tTTC $ UN 2 M9 � jlassachItsClio " bEPARTMENT OF BUILDING INSPECTIONS o A2 Main Street • Municipal Building INSPECTOR - -° Northampton,MA 01060 Applicant Information Name----------------------_------- — Location ---- ----- ------------ City--- ---- -------------------- ❑ 1 am a homeowner performing all work myself ❑ I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on thisjob. Company Name — >>U�',_–uc�_ iK> -- Address �ql2-1� �� ----------------- City— 0 Y, 7-00 — —__—Phone#5 X7 InsuranceCo.ZR5752-) 1.,1Sv4z f 1�-5 Policy# 10v�OAQl�;�--- Company Name Address City Phone# Insurance Co. Policy# Failure to secure coverage as required under Section 25 A of lYlGL 152 can lead to the imposition of criminal penalties of a fine up to$1500.00andfor one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement maybe forwarded to the Office of investigations of the DIA for coverage verification. I do hereby certify under the pairs and penalties of perjury that the information provided above is true and correct. o n q Signature �.�--� � G � Date Print Name d 601 u j2sf ? Phone 3r Official Use Only Do notwrite in this area to be completed by city or town official City or Town Permit[Licensef ❑ &uldincDeO 0 Liceminc Loud Check if immediate response is required ❑Seketr+ Dept Contact Person Phone 1 E] Health Dept. •sol;lioy}nu Bul}u©jB }luwiad algeolldde jay}o pue "-&CA% ollgnd +o }uaui}.iedap 'uolsslwuioo uol}Owr0suo0 441,1001.1 +o pJeoa ay} auo.ij s}lwaad pa.ilnbai lle ule}go pus s}uawajInboi Buluoz Ili i4}!M Alcluioo o} liapjnq s4ueolldde ue awalla.r }ou saop }luajad Buluoz o +o aouenssl :3- 97 <I � �xns�rr��.rs s,LLNVL r7aa�t 6 r��, :�s Q •abpaTAou4 Xvt Io 4saq aq4 o4 a4P-znooe pus anzq sr ura-Taq paurPquoo UoPe -Togur aq4 4eg4 XgT4.zao Zga.zaq I :uOTge0T9T4.zao • ET (uoT-.voor Y--aum-TOA �TZT3 sxooa butpvoa 3o # saoEdg bIITx.ZEa_ ,3Q # (6u-T:yzpd pa.iedi 6pTq snu-rw ease jo-� :aoedS uado% a6elool aaenbS 6p19 lg6iaq 6uiplin8 aeaa - :l :-j opis - s)ioeglaS a6eluoaj azis 10-1 6uluoz As pasodoad 6ullsix3 pajinballil I �IISYC bIITPT TTiQ pqp dq T=? POTTT9 aq -4 II TOD r-MU NOI.LKjigo x .10 ZIOK7 aL SDQ (TH-TH27(T SS HVJ LIKYZcT -TO 'aR'J Z7cTK0O HE[ LLSDW NOIXVHYO fNl = ' TT :uogeool pue adAl'azls aquosop'S3A 31 ON S3A Z,4jadoid age Jo; papualui suBls 10 suor ppe ao of sa6uego pasodoid Aue ajau;aJV :uogeool pue ad/4'azls aquosap'S3A 31 ON S3,1 &A4jadoid aqj uo;sma su61s Aue op -p� 21999 u. File No. �Qyhs 4ING PERMIT APPLICATION (§10 . 2 PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: 51a,0— Address: 2) WTelephone: 4—1116 7 2. Owner of Property: �7 i Ig 1J Address:—3 3 c c 6 Zook DR, o Telephone: 3. Status of Applicant: Owner _Contract Purchaser Lessee Other(explain): 4. Job Location: ) Parcel Id: Zoning Map# 0 Parcel#_ District(s): � O BE ILLED IN BY THE BUILDING DEPARTMEN R � 5. 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 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) " AtACFX:5BR0OKDR BP-1999-1040 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:BIoc :` ,�T' CITY OF NORTHAMPTON Lot:-001 Permit: Buiiding Category:replacement windows/siding BUILDING PERMIT Permit# BP-1999-104Q Project# JS-1999-1756 Est.Cost: $5300.00 Fee: $20.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: B & R Siding 100465 Lot Size(sa. ft.): 10018.80 Owner: LAIZER SHIRLEY A Zonin Applicant. B & R Siding AT.• 334 ACREBROOK DR Applicant Address: Phone: Insurance: 781 Bridge Rd. (413) 586-4167 Workers Compensation NORTHAMPTON 01062 ISSUED ON:61411999 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL VINYL SIDING & REPLACEMENT WINDOWS 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 6/4/1999 0:00:00 $20.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo