32C-243 (3) Z
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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
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♦ 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