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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. EB(a°16 Z Alterations
NORTHAMPTON, MASS. 19 Additions
Repair
' APPLICATION FOR PERMIT TO ALTER
Garage
1. Location �' r r a Lot No.
2. Owner's name 1 � '` Addressl�f
3. Builder's name lyei V1-01S N h Ol'-) Address L 4 tjC't,( V
Mass.Construction Supervisor's License No. C)10-A AQ Expiration Da e
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 g ( � (
12. Type of roof S �,t�� t i(f al) �d� r��� ('1 :1 t'ac rT Y f?A/ ?� ( 1;'I i/l V--Y 1 :!� l� �' c'�G1 I&
J J
13. Siding house
14. Estimated cosL-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief. p
Signature of responsible appucan!
Remarks
A221998 Glik Of Narthampton
� * � �btassacfltrsttts
DEPT OF SM ' t s0 lNcPF-e i `DE jARTMENT OF BUILDING INSPECTIONS
"°212 Main Street a Municipal Building '
Northampton, Mass. 01060
WORKER'S COMEPENSATION INSURANCE AFFIDAVIT
L CNJVU") _J�tWn4�aja
(licerlscclpermittee} - -
with a principal place of busineWresidence at:
LAA 1 L CA (phone#)
(st-eeUci ty/statrizi p)
do hereby certify, under the pains and penalties of perjury, that:
QQ I am an employer providing the following workers compensation coverage for my
employees working on this job:
gnsuzance Company) (PoUcy Number) tion 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) (Lm-aranc a Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expi.radon Date)
(Name of Contractor) !(Insltran(x Company/Pobcy Nurnber) (Expiration Date)
(Name of Contractor) (Insutamoe Company/Policy Number) (Expiration Date)
(attach addition!&bed ifne&nary to includc infarmsLion perisining to all ooatn a rs)
( ) 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 ttut wbilo homeowom who employ Person to do taaic"caaam cootniaioo or rrpair work on a dwelling of
W more than three emits in which the bonvowner resides or on the grouada appurtenant tbetsto aro not gwaralky coasidavd to be
euvloyexa under the worker's o=passation Act(GLr52,=1(5)),application by a homeowner for a Gomse or permit may evi kwe the
10921 status of an eUMPtoyer under the Wor ees Compensation Act
I understand that a dopy of this aal=nmt may be forwarded to the Depvbvy cW of taduhial Accideatf 08roe of Inaxs sloe For the
coverage verification and that failure to soauro ooveragc nutlet section 25A of MOL 152 can lead to the impoddoo of csimhW pntariies
ooatiaci<tg of a fine of up to$1,300.00 endlor of up to one year sad civil penalties in the form of it Stop Work order and a
Elmo of 5100.00 a day against ma
Signed this _day of _I L 1997 For dqurhneoW un only 1
Pt:rrnit Number
Map# Lot#
Si / of ulc+~pse Crtniti=
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_X
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 Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
' &paved parking%
# of -Parking Spaces
f fof 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.
_1
DATE: APPLICANT's SIGNATURE
}" NOTE: lase no of a zoning t `
g permit does not relieve an applio nYs; urden to oompfy w1t4,,pll
zoning requirements and obtain all required permits from t Board of Health, Conservation
Commission, Department of Publio Works and other applio to permit granting authorities.
FILE #
�UL 2 2 1998
DEPT GF n,: File No.
9-103
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: tqe can -�rt_3 +i
Address: 57� It Id, K1 '4t)n Telephone: n w"- I L;I
2. Owner of Property:
Address: 2U2. (AntAac LV . Telephone: f�
3. Status of Applicant: Owner Contract Purchaser Lessee
_Other(explain):.
4. Job Location: 2, r- A�'
a `_
Parcel Id: Zoning Map# Parcel# r District(s):��
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
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 KNOIV 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 Y_ 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)
Department: Reference No: BP-.1.99.9-0.1.03
....... . .... ..... . ...........
Building, Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
Roofing
...... REC-1.999-0001.70
......................................
Pa Paid in Full On:
Cyrus.Newman
.Tu e Jul 21
, 998
k ... . ...... . .................................................................. 1
. ............... .........
.........�ceived By: Ch eck No:
Linda Lapointe 1.362
.............................................................
......................................
DEPARTMENT'S COPY Amount: $20.00
......................
DIIPARTMENT FILE COPY 262 BRIDGE ST
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:
22 Jul, 1998 BP-1999-0103 $20.00
GIS#: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
4448 25C 062 001 262 BRIDGE ST URB 20081.16
Contractor: License Type: Insurance:
Cyrus Newman CSL Workers Compensation
Address: License No.: Insurance No.:
697 Bridge Road 064690 NEWC913927
Li!Yi State: Zip Code: Phone:
NORTHAMPTON MA 01060 (413) 586-1093
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0144 roofing $3,000.00
Description of Work:
STRIP 1/2 ROOF & SHINGLE
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: