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e� Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 0 Alterations
a Garage
NORTHAMPTON, MASS. >1 0 Z 1981 Additions
APPLICATION FOR PERMIT TO ALTER Repair r�ti�
,GZ CA
1. Location 2 j.o ntA 6L T\f'7" {' � �Q . Lot No.
c
2. Owner's name _`/�l_Xl-14 f—YA1y)C?,'-) Address
3. Builder's name Address U ' On ci ckra
Mass.Construction Supervisor's License No. C 5(Dcf-). q LA 0 Expiration Date�'aej
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 fIAn A0, V-(-
13. Siding house
14. Estimated cosL-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and be lief.
1
Signature of responsible appicant
Remarks
(rife of 'Wort4alli rtan
+ ':.� �Itasargnsrtta
DEPARTMENT OF BUILDMG INSPECTIONS
i 212 Main Street a Municipal Building
k. Northampton Maas. 01060
��. F W,
:
_ w WORKER`S COMPENSAT>`ON INSURANCE AFFIDAVIT
(Iloeasalpt:rmittx}
with a principal place ofEiusinessiresidence at:
(stz,oct/ci ty/stairJrip)
do hereby certify, cinder t.iie p?.ms and penalties of per3tuy, that:
QQ 1 am an employer pro,,6ding the following worker's compensation coverage for my
employees worlQng on thi5 job
CO.
(Insurance Company) (Policy Number) 1`�tioa Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors fisted below who have the following worker's compensation policies:
(Name of Contractor) ._^ (Insurance Company/Poi cy Number) (Expiration Data)
(Name of Contractor)- (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) �On$uraric:c Campany/Poliey Number) (Expiration Daze)
(Name of Contractor) (Insurance Company/Policy Numbs) (Expiration Date)
(attach sdditicond sheet ifnoceisuy to me ludr mfonnA60 a pera inio6 to all ooatrectors)
( } I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be snare*a%wtrilo b0m0ownera woo etuploy Paso=W do M*kU --k wamu Lion or m air work on it a+vlling of
not more thaa Ibsee%tilts lei wbicb%be boweow=mdse or on tho eeauads sppu Unus tbsnto ate pot paarNly axnidetW to$o
ezvloya=W26a the worimt oo=pcusstian Act(G LI 52m I(S)�application by s Som&W=far a Getma a permit may-Max*the
legal&tams of an"WloyW#odic the Worker's Coaq+emaUou AA
I uadastAad font a 0Wy of this w a 3Am s way be fenvatdad to too Depuvnow of b.&,drio!Aeadaatd Offi0+of h for tts
ooyamp vft-Mcatioe sad that fWufe to scaure coverage candor eoalon 23A of MaL 132 caa 1W to the is P�M cf tximaul peneW=
ooasisti of a Sae of up to t 1,304.00"Swor bnprisonmaA of up to am ytxr tied civil pemtWts is the form of a Stop Work Or4w an"
fine of 3140.00 a clay ttgast*WA
Signed this l �daY taf_ -�, I99Q For a �°°°n - —
Permit Number
Mapo __Lot#
SI of LiCcn. 3CUPCrIIttt� _—-
10. Do any signs exist 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 colt 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 parkingi
# of "Parking spaces
f of 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.
D�'lE: �f APPLICANT's SIGNATURE I&NOTE: lasu6nole of a zoning permit does not relieve an a lloant's burden to oomply wltb all
zoning requirements and obtain all required permits fro the Board of Health. Conservtstion
Commission, Department of Publio Works and other ap oable permit granting authorities.
FILE #
IL
pR File No.A0qg I
g l f t
L 1PdSPECT��`rrS
PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: j(l):S N p WM n
Address: I a- n P 160 Telephone: 5 v(o - loctz
2. Owner of Property: �-)A1 a'(+ "Sniomnn
Address: Z()? (' It Q`�"j)* txk`• Telephone: -524 o - n
3. Status of Applicant: Owner//�� ,� __ Contract Purchaser Lessee
_Other(explain): t Cj5-)- -rCt C f
4. Job Location: ZGZ 1 .ks2nA iqu - S}-.
Parcel Id: Zoning Map Parcel# 3 District(s): &14w .
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property f e,`ji((L,.L:4ioj
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
rnckncj uys It U V e t) F ,,t t
r J
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)
202 CHESTNUT ST BP-1999-0876
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A- 143 CITY OF NORTHAMPTON
Lot:-001
Permit• Building
Categry:roofm BUILDING PERMIT
Permit# BP-1999-0876
Project# JS-1999-1522
Est.Cost:$5000.00
Fee:$20.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Cyrus Newman 064690
Lot Size(sa ft.): 21692.88 Owner: SOLOMON STUART F
Zoning:URA Applicant: Cyrus Newman
AL. 20 CHESTNUT ST
Applicant Address: Phone: Insurance:
697 Bridge Road (413) 586-1093 Workers Compensation
NORTHAMPTON 01060 ISSUED ON.412211999 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 4/22/1999 0:00:00 $20.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo