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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. [' 10 .q 19_qa Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location 2-u Lag Q R &,jNxe , Mck 0 i0to 7 Lot No.
2. Owner's name /1QrN Address �'`� L❑X� �1�1'�iYt�
3. Builder's name l_ t rt) �°C1�)rnl��� Address-aa} RYi CA CaP r't_
Mass.Construction Supervisor's License No. LQY 1 o q® Expiration Date 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 Q (C Q {.✓i e I VAS C, (Aaf 5 k 42
13. Siding house
14. Estimated cost-
The undersigned certifies that the a e statements are we to the best of his, her
2 . knowledge and belief.
-� i
Signature of responsible app,icanr
Remarks
�hANp
B �lassarilasetta
FEB 1 01999 _
DEPARTMENT OF BUILDING INSPEcTIONs
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFk30DAVIT
L Ci�5 .t-A n-'a,C,
with a principal place of business/residence at:
A4 f�_.LA — (phone#)��
(stMWCity/statehip)
do hereby certify, under the p?ins and penalties of perjury, that:
00 I am an employer providing the following worker's compensation coverage for my
employees working on this job:
GXL'A • _ �1 tw C q _ MOAA 1 a�
(Insurance Company) (Policy Number) Sion 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 Dale)
(Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date)
(attach additioml shed iftia=2 ty to include information peruiniag to all ooe4wion)
( } I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:pltxae be aware that while homoowmera who employ peso=to do am4wenaaa cousmaioa or repair work on a dwelling of
not more than three units in which the b o meow=ro idea or 00 the grounds appurtemwl thetdo ace not gtmeralty oocsWered to be
to Playas under tba wurimt cm persatim Act(GL152.=1(5)�application by a homeow=for a liansG or permit may evide=the
4621 otatua of as employer under the Workeea Compamatiou Ant
I uodetstaa4 dub a OWY of this statemam may be forwarded to the pepu%nu t of laduitrial Aecidentf 096oa of Lrauranco for the
coverage vetificatioa lead that failure to Beaus coverage tauter section 25A of MOL 152 can lead to that impo%Woa of txiaii peatWes
000siatimg of a fine of up to SI,500.00 tatdor l of up to one year sad civil pentWes in the form of a Stop Work order and a
faro of 5100.00 a day against ma
Signed this day of 1991 Ford xtuseoory
Permit Number
Si Map# Lot#
Liccnsee/Pcrmitt=
10. Do any signs ebst on the property? YES NO�__
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 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 parkzngli
# of Parking spaces
f of Loading Docks
Fill:
(vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true nd accurate to the best of my knowledge.
D24'1'E: APPLICANT's SIGNATURE
NOTE: Issu ® f a zoning permit does not relieve an app ant's burden to oomply wit4 ,all
zoning req i aments and obtain all required permits from lye Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
FEB 1 01999 m0 I q6 k�
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of,Applicant: f n
Address: l o(�"f a C CP rid . Telephoner
2. Owner of Property: LQ:�12 140e-&4
Address: Z-� LWL C� . Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
_Other(explain):
4. Job Location: Z. y L, 'X . j1 6:E, Cj(��iVl( P
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property g.,,a h 2: p
6. Description of Proposed Use/Work/Project/Occupabon: (Use additional sheets if necessary):
t_
rnc--� j jl, od Q r e ni r�o j►)�kLh Qd's-n d a _
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/Vadance/Finding ever been issued for/on the site?
NO DON'T KNOItir�_ 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)
2 LAKE ST BP-1999-0686
CIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:Iit 1 '1t ",�o CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: roofing BUILDING PERMIT
Permit# BP-1999-0686
Project# JS-1999-1273
Est. Cost: $3500.00
Fee: $20.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use croup: Cyrus Newman 064690
Lot Size(sq. ft.): 12283.92 Owner: HARDY DANIEL R
zoning: URB Applicant: Cyrus Newman
AT. 2 LAKE ST
Applicant Address: Phone: Insurance:
697 Bride Road (413) 586-1093 Workers Compensation
NORTHAMPTON 01060 ISSUED ON.•2110199 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/ Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 2/10/99 0:00:00 $20.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo