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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. / Tel.No. J22-3-5:X/ Alterations
NORTHAMPTON, MASS. l3 19 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location �Y/�v �cb2���i� Lot No.
2. Owner's name ,Y +/ 2c ti Lr)lts� Address (6/ ✓12 Fcrirz�Ve�
3. Builder's name i�e,r .i � � Tip Address ��Qsr
—
Mass.Construction Supervisor's License No. Ca`3 7z Expiration Date /A /z'v
4. Addition
5. Alteration Ji®v�a rrugGF.ins..ir— --
6. New Porch —
7. Is existing building to be demolished? /`!o -
8. Repair after the fire d
9. Garage /\�&.) No.of cars Size
10. Method of heating /loo
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cosL- 0-d
The undersigned certifies that t above s are we to the best of his, her
knowledge belief.
i
ignature of resp nsib pp icons
Remarks %2ikrwd,r cz�ir✓�la,-) 147.1✓�
irt/ /C� .%n rfi-rx.EO r5.®Fi✓i ov �' •�vn .�rt�ri� J�yr��,r-u �•�`E���t �,''�
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asjs'5 DEPARTMENT OP BUILDING INSPECTIONS
NZO- A iP TOH N6 01 CoU, 12 Main Street ' Municipal Building '
Northampton, Mass.• 01060
WOMCER'S C012PENSATSON INSURAPCE AFFEDAVIT
N censccJpermi ttcc)
wILL, a principal place of business/residence at:
(s��t/ci ty/stalrJa p)
do hereby certify, under the pains and penalties of pegury, that:
O I am an employer providing the follo`ving worker's compensation coverage for my '
employees working on this)ob.
(Itir =(x-' Company) (Policy Number) (Expiration Date)
I am a sole proprietor, general contractor or homeowner (circle one) and have hirers
the contractors listed below who have the following worker's compensation policies:
e111 11��f
(f lame of Contractor) (Lnsu,-ncc Cotnoany/PoU \ut_icr) (" ;i-adon Date)
(vamc of Contl clor) comoanyipoti Nuim--r) (EXDIM,don Date)
(Name of Contactor) (insurance Compauy/PoL•cy Ntunbe_r) (Expiration Date)
(Name of Contractor) (Insurance Comoaay/Policy Number) (Expiration Date)
(attach.`_dditiCCA shCC(if nccCxuy to inc}udc infocm�ica perL imng w elJ aodr—on)
( ) I am a sole proprietor and have no one wor4•ano for me.
( ) I am a home owner perforrom.- all the work myself.
NOTE:plcasc be aairc that NVanJo hoancoµnm H'ao naploy perconi to do m.' .nr c.coasauaaoQ- r rcpair.vork an s d-xiling of
not mote thin tbroa uaits is NvEuch the bamcouv<r maw oc no tbo crounds appurtcn_nl thcr o arc cot Eaocra11Y oomadcrcd to be
cmploym undo tba vvoa K=c s ocmpasstioa Act applici6ou by a homcovmcr fora Gccwtc cc pcsmic may cvidcnoc the
ups ruh, of an ecnployot under tba Workces Coanpomation Act.
I uodcsst,nd that a copy of dii mtcmcat may ba fomvrd.d to Lb-Dcpartmms of l.&u fti d Axidmta'OfSoo of Iraur+aoe for tb.
covaagevaificatioa and that&Hum to socum co under socaoa 25A of b101.152 eao Iced to tbd impo=tloa of erimmsl paislbcs
oomisIIug of x fine-or up to S 1X00.00 and! of u p to one y=and gv�pasr ltia;a the form of a Stop W ocic Ocdcc and a 1
figo of 5100.00&.4y agatiast
For&P i&"m +ii°o°lY
. . . Pezmit-Numbes .
Si o i cimit3cc
i
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 MAST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This colu= to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parkLng)
# of Parking Spaces
# of Loading Docks
Fill:
Avolume -& location)
13 . Certification: I hereby certify that the information con Pained rein
G is true and accurate to the best of my kn77-,e e.
DATE: APPLICANT's SIGNATURE u
NOTE: Iss an of a zoning permit does not relieve an ap ioant's urden to oomply witlr'$II
zoning ui ements and obtain all required permits from the Board of Health. Conservation
Commisslon, Department of Publio Works and other applloable permit granting authorities.
FILE ,
Jh
P !
3 , NOV 6 1998
3'=p I , File No
�10
�, IIQI�'tlt-t`r�S;�("TQ(1 vii
!.h4A Qtlr�r7 .�
ZONING PERMIT APPLICATION (§10 . 2
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: lQ ti: -ST6z�-�: ��� Telephone:
2. Owner of Property: \��'y tn c tt
Address: F31 tC_Nv-P.N 6k)"4p Telephone:
3. Status of Applicant: Owner _Contract Purchaser Lessee
Other(explain): cC>-'S7XLa-c.,rapt
4. Job Location: _t)]_ �(t3s�
Parcel Id: Zoning Map#__s2',C,- Parcel# < District(s): l �
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/VVork/Project/Occupabon: (Use additional sheets if necessary):
ICA_✓Y; ) e' rzr22. /Qtxq) C"a /YL�ili
UNIT ��t�14 "Ddz`/�) C: Sttf hrki/L znjLiq
utJ vT-_
7. _ 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.
& Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNO::I_ �-' 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�9 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-1999-0480
...................................
Building, Electrical & Mechanical Permits
........... .............................................................................
Fee Type: Receipt No:
replacement windows Rl,"C-1.999-001290
.........................................................................................
..... . ..............................
Paid By:
Paid in Full On:
Brian Greenwood Fri Nov 06,1998
.........................................................................................
.. . ...... .....
Received By: .Check. . .No ...................
Linda Lapointe 2368
.........................................................................................
......................................
DEPARTMENT'S COPY Amount: $20.00
-------------------------
DEPARTMF,N'1' FlLE COPY 81 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:
06 Nov, 1998 BP-1999-0480 $20.00
GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size:
2648 22D 006 001 81 RYAN RD URA 35719.2
Contractor: License Type: Insurance:
Brian Greenwood CSL
Address: License No.: Insurance No.:
366 East St 053724
City: State: Zip Code: Phone:
EASTHAMPTON MA 01027 (413) 527-3531
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0913 windows replaced $750.00
Description of Work:
INSTALL REPLACEMENT WINDOW
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: