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29-141 (2) O r Z pm s k N M Z J Z a Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MASS. 19 Additions APPLICa ATION FOR PERMIT TO ALTER Repair Garage 1. Location V 7-5 y o—71 d, Lot No. 2. Owner's name ` /W L"A )-- 7-0/y Address 3. Builder's name F aP A N K ,(� a S/ o2 S k A d d r e s s 0- (f 114 P74 Mass.Construction Supervisor's License No. / 6 Expiration Date 4. Addition 5. Alteration 6. New Rmh /V e—(A.) .� -2 C l a 1 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:- cl� The undersigned certifies that the above statements are we to the best of his, her knowledge and belief. Signature of r able app icant Remarks a e 2 61998 3 . Cf T oaf 'Wart4a tptou ��±± _ FKJt7assacflnsctta DEPARTMENT OF BumDrNG INSPECTIONS • -fD � `�ti 4 Vf i�� _ 212 Main Street ' Municipal Building Northampton, Mass. 01060 y WORICER'S COAITENSATION INSURANCE AFFIDAVIT I N lK - lr'd-S d �j J L JicrosecVpermlttee) %vith a principal place of business/residence at: /lid Y / y o/e 3t 14 / (phone#) - 7 9 -5 7 (Sts=t/city/state/rip) do hereby certify, under the pains and penalties of perj,,_1ry, that: ( ) I am an employer providing the fo11o`ving wor'Ker's compensation coverage for my employees working on this job: S ., l f �= (� `) e J� (Insurance Company) -- (Policy Number) (Expiration Date) ( ) I am e proprietogeneral contractor or homeowner (circle one) and have hired the contractors listed below who have the follow:ng woi'II-I(,r's compensation policies: A10 a -- (ii<ii1C Ol COIICiFnctoc l[l ...,.... Jli'^ ;i1 0.l: il`i - -- `:J1ra1 o— D')'te) (Name 01 Contractor) (InsZtrance Com-��Izly/Policy Nulutzs) (Ex�nmbon Date) (Name of Contractor) (Insurance Compa�y/Policy Number) (Expiration Date) (attach additioa.l if n'cc.ry to inc}ucic infornuticn .wising to.11 mitradu:3) ( I am a sole proprietor and have no one working for me. O I am a home owner performing all the work myself. NOTE:picot be aware that,kilo homcoµnm�Ntw a:-ploy perwm to 63 main+ . cc,ax_ruction or repair work on a dwelling of not meta than thrco units in tench tlx bam» Nmcr residca a oa the groun.il appurtenant thada arc oct 9'.' y—'dcrcd to be employers under tho worktts onaTa 4oa Act(GI-152,u 1(5)�application by a homcowtxr for a license o<permit may evtdcaee tho legal aaiii4 of an employor under dw Wort ce&Compcnz.tioci Act I undc�d this a copy of this rtdcmcal may bo to tha Dcpn<tm-a2 of In�iatrinl Arcidcn&Offi° of L—ur■rKO for the oovcrage verification and that failure to uxttre coy at -o under sce oa 25A of b1(1L 152 can Icad to the'imposition of criminal penalties comistmg of a fine of up to S 1,50.0.00 artd/«impri3omrx�of sip to erne year nod civil pcIzitics is the form of a Stop Work Qrdcs and a fu o of 5100.00 a.3.ay against tvc For dgmtw-w uio oaly Permit Number Siguatmc of Lit Cmdu m Lot# i t s pve �- F- s iiiv� SL� � d2 X a 1 c- C- � �C I� eTUiee �, w �( �, e bad % A,4 L- X164 Tle (/" / L Lr r l �o P y e s v'' e s _ j AUG 2 6 1998 DEFT OF 5 < � 1Z o y� . -01 L � t / I { y r � i AUG 2 7 X998 ' fJ r �y t fAV � may, r SLO- b c. Al , c � _ s r 10. Do any signs exist on the property? YES NO x 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 —1-= to be filled in by the Bcflding Department Required I Existing Pr sed By Zoning Lot size ° y /Vel IY'r c� ?e->, 4 � CXs Frontage r c� Setbacks �~3 - side L: 3s� R:a C"' LP;26' R: / / �- - rear Building height �.�� ' /, Bldg Square footage 3 r 2 LI %Open Space: 76 (Lot area minus bldg &paved parking! # of Parking Spaces f of Loading Docks N� Fill: {vo1-ume--& 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: 1 uan a of a zoning permit does not relieve an applicant's urden to 0roins wltl� .011 zoning requir ments and obtain all required permits from the Bo of Health ervulion Commission. Department of Publio Works and other applioable permit grantin oritjos. FILE # 4 0261 File No. ZONING PERMIT APPLICATION (§I0 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: Flq Address: Y No' �cL o r s Ur71e Telephone: _2 6 -k - 7 3 At Ct ss_ 2. Owner of Property: ,A 4 N La t- LG tV Address:—, 7S 4 G N c-0, Telephone: 3. Status of Applicant: Owner _ Z Contract Purchaser Lessee Other(explain): 4. Job Location: '4G vyt Parcel Id: Zoning Map# %'�- 1 Parcel# District(s): (TO BE FILLED IN BY THE BUILD NG DEPARTMENT) 5. Existing Use of Structure/Property Tom'/k 6C- 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): X r 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 KNOlti'_ 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_-Z_ 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) �5 _ �- FILE # L; ` AUG 2 6 1998 APPLICANT/CO`Kj'7ACT PE ON: C96 /�3S DEPT© °DRESS/PHONt: Av AkeA C1 PROPERTY LOCATION: MAP PARCEL: ZONE THIS SECTION FOR-OFFICLAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZC)NTNCr F()RM FTT,T,FT) OUT Fee pqiri Fee Paid /X76 Z'vnf, of C cinctrurtinn- Addition to Fyisting ArrPCsfi Structure 13ni1dinz2 Plnr_ nc Tnrliided- (1wneC/ rru�ant �tatPmPnt nr T irr�ncP # _ --'� 3 Sete of Plnnc / Plot T OLLOWING ACTION HAS BEEN TAKEN ON THIS APFLICATIOM Approved as presentedfbased 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: § NN/ZONING BOARD OF APPEAL S 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-Bd of Health Well Water Potability-Bd Health !Permit fLwp Consery o issiou Signature of Building Inspector Date NOTE: haauanoe of a zoning permit does not relieve an applionnt's burden to oompty with all zoning requirements and obtain ail required permits from the Board of Health, Conservation Commission, Department of Publio Wor" and other applionble permit granting authoritles. Reference No: BP-1999-0246 Department: ................................... Building, Electrical & Mechanical Permits ......................................................................................... Fee Type: Receipt No: Building- Renovation REC-1999-000587 ......................................................................................... Paid By: Pa.id..i.n.F.u.I.I..0.n:.......... F...r..a.n.k Kosi.o r . M. on Aug. 31,1998 . ... •...... . .. ..............Received By: C h eck No:................... Linda Lapointe 1.870 ......................................................................................... ...................................... DEPARTMENT'S COPY Amount: $40.00 ........................... 1)1�PARTMENTFILE COPY 275 RYAN 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: Tracking No.: Fee: 31 Aug, 1998 BP-1999-0246 $40.00 GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size: 4866 29 141 001 275 RYAN RD URA 20603.88 Contractor: License Type: Insurance: Frank Kosior CSL Address: License No.: Insurance No.: 4 North Kellogg Rd 018622 Liy_i State: Zip Code: Phone: HAYDENVILLE MA 01039 (413) 268-7935 Project No: Category of Work: Const. Class: Cost Estimate: JS-1999-0513 alteration-addition $2,260.00 Description of Work: CONSTRUCT WX 12' DECK GeoTIVISS 1997 Des Lauriers&Associates,Inc. Signature: