23D-031 (4) Department: Reference No: BP-1999-0012
Building, Electrical & Mechanical Permits
Fee Type: Receipt No:
Roofing REC-1999-000018
Paid By: Paid in Full On:
Cyrus Newman Mon Jul 06,1998
Received By: Check No:
Linda Lapointe 1342
DEPARTMENT'S COPY Amount: $20.00
DEPARTMENT FILE COPY 43 MILTON 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:
06 Jul, 1998 BP-1999-0012 $20.00
GIS #: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
3192 23D 031 001 43 MILTON ST URB 10759.32
Contractor: License Type: Insurance:
Cyrus Newman CSL
Address: License No.: Insurance No.:
697 Bridge Road 064690
City: State: Zip Code: Phone:
NORTHAMPTON MA 01060 (413) 586-1093
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0020 $3,000.00
Description of Work:
strip& shingle roof
GeoTMSO 1997 Des Lauriers&Associates.Inc. Cianwfi,rs.•
q �.a. = 1 5 f
JUL 6 "998 3
File No. -----1 9--- i
DETU� 64019
RH3UF1"?Ottt
tv,AQ1CS
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: j--ei.-,-- --h V. -wy"zgH s (2cm 5
Address: 6 T 7 j va.0 Telephone: 57-6 — rd 9 4
2. Owner of Property: Mc.ve 'r ,S.'vv-1
Address: 6? 4% /VT D // 5F rib Telephone:
3. Status of Applicant: Owner X Contract Purchaser Lessee
Other(explain): ��/�/�J f /�
4. Job Location: 0 L 3 G'f" ?, /�ol'/ ._5---A-
Parcel Id: Zoning Map# cj1, Parcel#3) District(s): '1
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)"
5. Existing Use of Structure/Property_ s c Oe/') C
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): •
�/Ve-ts() e A,‘5 I Iv) k_Go r=i v1 `` 7")5-/ // 4 g av 11-5 ft? I
1r 6 i LA,cf 1-t D4r-rt 74-(`'? C
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 PermitNariance/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)
,
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 column to be filled in
by the Building Department
I 'Required I
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 parking)
# pf -Parking Spaces
# fof Loading Docks
Fill:
=(vol-ume -& location)
13 . Certification: I hereby certify that the information contained herein
c is true and accurate to the best of my knowledge.
DATE: ` , 6/9� APPLICANT's SIGNATURE / le------ NOTE: Ia is oe of a zonin ermit does `_ 9 P not relieve an a li a pp burden to comply with +plt
zoning requirements end obtain all required permits from t e Board of Health, Conservation
Commission, Department of Publio Works and other applicable permit granting authoritles.
FILE if
.ttAMp ......
i���..'.�, r'i! .blassatlfasttts — I.—
e 1. ,�� ii
JUL 61998
DEPARTMENT OF BUILDING INSPECTIONS `'_�f
Main Street ' Municipal Building '
DEPT tit $rift CiliG Ii:SPECT`►� _.,.
hORTHAt"P(Gfi,ti.,,'-k 010SO' _,.Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE A}'11J)AVIT
I, Ci r)3 t•‘4.WmaAel
(lipermittee)
with a principal place of business/residence at:
(J I C �, - (phone#) , 0- 1Ot
J (street/city/state/zip)
do hereby certify, under the pains and penalties of perjury, that:
OQ I am an employer providing the following worker's compensation coverage for my
employees working on this job:
Calic Ins. CO. tJc3.)Q el VVIt . �__1� ,‘aqq
(Insurance Company) (Policy Number) (Expiration 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) (Exopiration Date)
(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 Date)
(attach additional shed if necessary to include information pertaining to all coatradors)
( ) 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 that whiles homeowners who employ persons to do maintenance,construction or repair work on a dwelling of
not moo than three units in which the homeowner resides or on the grounds appurtetwn thereto are not generally considered to be
employees under the wockett compensation Act(GL152.aa 1(5)),application by a homeowner for a license or permit may evidence the
legal status of an employer under the Worker's Compeoaation Ad.
I understand that a copy of this ttatemma may be forwarded to the Department of Industrial Aoddeee'Office;of Insursoce for the
coverage verification and that failure to aeeure coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties •
consisting of a fine of up to$1,500.00 and/or imprisonment of up to one year and evil penalties in the form of a Stop Work Order and a
fulls o(3100.00 a day against tie.
Signed this (D day of -JL)I L 199 t Far departmental use airy
Permit Number
Si of Licensee/Permittcc MaP# Lot#
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 5E!LO- I D'-i3 Alterations (1\Pto P
itii.%��� �L�NORTHAMPTON, MASS. 1l t0
Repair
t;14-i APPLICATION FOR PERMIT TO ALTER
19 Additions
''"11 Garage
1. Location I 3 ILI i I-119n 64-. (4Qf-l4�t •1-t9►r) Lot No. 073Vl -3/ .1-
2. Owner's name VUA(L,r:C7 5i YYLeei►AQ _ Address 16C1. f. apt-e Eck-
flO(e.' (•e.
3. Builder's name Qy aIS 1J�l t..)rC.r7 Address LA-4 ILL ciSe_ • Ki(`7Y4 .p,t..0-011
Mass.Construction Supervisor's License No. Clot- _0g° Expiration Date 14I 1 \qq
4. Addition
5. Alteration ; p exo-h corpg AD, l'Infiste.ri 0 g� l it... -- p
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 aSpttna
13. Siding house
14. Estimated cost-
o/� The undersigned certifies that the above statements are true to the best of his, her
LJ knowledge and belief.
73 (0 '
Signature of responsible applicant
(4
Remarks