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32C-243 (3) Z 70 V M Z = O ..j .. Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MASS. ...Juh 7 Additions ' APPLICATION FOR PERMIT TO ALTER Repair Garage 1. Location — 7 Lot No. 2. Owner's name �I' s`'T s✓!7� Address t 3. Builder's name + Address Mass.Construction upery isor's License No. d ' f20 Expiration Date yy 266 l 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 ' z - , o G J. 13. Siding house t 14. Estimated cost- ` Q The undersigned certifies that the above statements are true to the best of his, her knowledge and belief. Si�,ure re sponsible app,icant Remarks . 1 limp , #I�ttnttnn J 'n ♦ I ?0f p' .; fTRSERCI(RStll4 DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT C'I�u tw ryka (L censec/permittee) with a principal place of business/residence at: 4 i-�n(in P-_ U . (phone#) .f�)&- �Oq� (str-eet/ci ty/stat dzi p) do hereby certify, under the pains and penalties of perjury, that: A I am an employer providing the following workers compensation coverage for my employees working on this job: d Ins. Co Nc � q I�q 2.� w1 n. 1aq (Insurance Company) (Policy Number) T ration 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 Date) (Name of Contractor) (Insurance Colnpany/Policy Number) (Expiration Date) (attach additional shots if neccxsary to include infnrmarion pertaining to all ooadiacton) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing ail the work myself. NOTE:please be aware that while homeowners who employ persons to do ma aenance,comuvction or repair wonk on a dwelling of not more than three units in which the homeowner resides or on the grvunds appurtenant thereto are not genemlly considered to be employers under the vmd='s oompeass4ca Act(GL152}s 1(5)�application by a homeowner for a license or Permit may evidence the legal statue of an employer under the Woriceez Compensation Act I understand that a oopy of this cWcaneEd may be forwarded to the Depwtmc jd of Industrial Aocidan3 Offioe of Insauanoe for the coverage verification and that failure to secure coverage under section 25A of MOL 152 can lead to the a imposition of criminal Penalties ooasistiag of a&net of up to S1,500.00 and/or imprison#of up to one year and civil penal ties in the form of a Stop W oric Order and a fine of S 100.00 a day against tae. .,Signed this_Z Jay of J 1) For dquzimer¢al case ontY Permit Number gyp# Lot# Signature f Licwsee/Permittee 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 MOST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. This columa to be filled in by the Building Depnrtmnnt I 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 parking! # of -Parking spaces htof Loading Docks Fill: -(volume--& location) 13 . Certification: I hereby certify that the information contained herein G is true and accurate to the best of my knowledge. _1 DATE: ui,,f /°' ,_�o APPLICANT's SIGNATURE NOTE: Issuanol of a zoning permit does not relieve an app ant's burden to oomply With_4kll Czoning requirements and obtain all required permits fro the Board of Health, ConserV ation ommission, Department of Publio Works and other applicable permit granting authoritios. FILE # JUN 7 20G0 File No. n - ZONING PERMIT APPLICATION (§10 . 2 PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: xc%� rn r Address: X 7 Telephone: s d'6 jU 93 2. Owner of Property: - /` u� /T5 4�;✓c Address: evkal 'r- -s Telephone: 3. Status of Applicant: Owner Contract Purchaser _Lessee Other(explain): &'e . 4. Job Location: e /�a� 74' Parcel Id: Zoning Map# a� Parcel# O)gJ District(s): ZZAZ (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property 6. Description of Proposed UseNVork/Project/Occupation: (Use additional sheets if necessary): -I-I iT 14 JdL 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 KNO::l___),/ _ 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-4— 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) 116 HAWLEY ST BP-2000-1 101 GIs#: COMMONWEALTH OF MASSACHUSETTS OPIMM--Block: 32C-243 CITY OF NORTHAMPTON Lot:-001 Permit: Buildinq Category:roofin g BUILDING PERMIT Permit# BP-2000-1101 Project# JS-2000-1966 Est.Cost: $3500.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Cyrus Newman 064690 Lot Size(sq.ft.): 4791 .60 Owner: HEBERT PAUL E JR zoning:URC Applicant: Cyrus Newman AT: 116 HAWLEY ST Applicant Address: Phone: Insurance: 697 Bridge Road (413) 586-1093 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:617100 0:00:00 TO PERFORM THE FOLLOWING WORK.-SHINGLE ROOF OVER 1 LAYER EXISTING, ADD VENTING 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 Occu anc signature- Fee Type: Recei t No: Date Paid: Check No: Amount: Building 6/7/00 0:00:00 2199 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo