28-051 (7) 9 OCT 19 1999 j� JUxs.;C> urctts
DEPARTMENT OF BUILDNG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass.' 01060 ,
WORKER'S COYTENSATTON INSURANCE AAFFMAVIT
(licenses/permi��ee)
with a principal place of business/residence at:
#"G ` 6"J7 . F4&Z-b�-(, hone#) L3 7 z
(Str=t/ci ty/stalfla P)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following wor-ker's compensation coverage for my
employees working on this job:
(Insurance Cody) (Policy Number) (Expiration Dale)
( ) I am a sole proprietor, general cona-actor or homeowner(circle one) and have hired
the contractors listed below who have the following workees compensation policies:
(Name of Contractor) Rasur--n(-- Courpwry/Policy Numb,--,) (Expiration Date)
(Name of Contractor) (tmuraancc Compauv/Poticy Number) (Expiration D21e)
(Name of Contractor) (Insurnc-- Compaq}•/Policy Numbe-r) (Expiration Date)
(Namc of Contractor) an uranm Company/Policy Numb--r) (Expiration Date)
(attach additioasl t,'ocs if n,oc co mc�sdC is fo�uaou�crtaiaiag cn.11 oo�-a.�on)
I am a sole proprietor and have no one worming for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aw2m tbat kilo boaxa++M=Hbo employ pawns to do cmLdc, acc coq:= ioa•or r )ak work on a d"dGM9 of
not moso than tbroo uaits is wbich the bomoowncr ncsuk�or oo the Vv,.n,s sppurteasat ML t arc Da scnatlly wasidard to be
aapleyas undcr tba wock"'I C0MP=sstiea Ad(GL1524 z 1(5)).sppUmdon by a bomwwxr fora GCm-e oe permit taay-id—the
legal status*ran employee under the wadcae.coarpemdion Ad
1undest,iadthatacopyofthUca—A may be forwadadto the DVp.ftmaofLaduaoielA 026OeofI=—fxd-
carcrage VQT= wd and that fatUu=to&taut covas go tmdcr%o*Cuoa 25A ofUOL 152 as lad to tbi °Q of c6minl p=4sa
ooatiztiaS of a Fme ofup to 51 0000 soda im•,�risoamcnt of tip tame yex and dv1 p=Sa is the f«m of a Stop w«lcOedrxand a -a
Ella of S100A0 1 day sgtinst tt)G •• •.
For dva�ites onx
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No� Alterations
NORTHAMPTON, MASS. 19V Additions__.
• Repair
' APPLICATION FOR PERMIT TO ALTER
Garage
1. Location —YA,( �1, `"� Lot No.
2. Owners name �A r"L� 'f- AOM C-`7 ajf W L, Address �2 P Y� /—
1CC^��` (eft - l� ✓ -�t Address e'er W ti
3. Builder's name r �
Mass.Construction Supervisor's License No. 15-6 P y-Q Expiration Date BUR)
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 S
13. Siding house
14. Estimated cost-
7 The undersigned certifies that the abo s cmc are true to the best of his.
knowledge and belief.
Signature of responsible applicant
Remarks
Qc sue. L C 7-Y
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 aolma to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
i"
Setbacks frn n f /
- side R: FP° L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg '
&paved parking) f,
# of -Parking spaces/
f of Loading Dock
Fill:
(volume--& loc tion)
13 . Certification: I hereby certify that the informs ion contained herein
is true nd accurate to the best of my knowl
DATE: j ) APPLICANT's SIGNATURE
NOTE: lssuan a of a zoning permit does not relieve an applioan s burden to oomply Wpi�-all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appiioabla permit granting authorities.
FILE #
OCT 1 91999
File No.& OQclzlotl
ZONING PERMIT APPLICATION (§10 . 2
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: /'(Cf AkV -(P4 Al
y -57Z- -(Address: �' � Lt=-�c'ti�L`7 �� Telephone: �- `i' -
2. Owner of Property: '"o'S f'- � ' C y �O.J L �i/ __2W7
Address:__. 62—L( '"::70 Telephone: -5 1?C_ 13%C
3. Status of Applicant: Owner Contract Purchaser Lessee
X�. Other(explain): CC,^.i to-tZ]2
4. Job Location: L 2_�-K / `7 A- F &'o"' d-e-e-.C3�
Parcel Id: Zoning Map# C)/ Parcel# District(s): St<
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property C C-Oa Pte} v-i t---Y -h9-
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
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 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_1�._ 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)
624 RYAN RD BP-2000-0404
G1S#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:28-051 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:roofing BUILDING PERMIT
Permit# BP-2000-0404
Project# JS-2000-0696
Est. Cost:$4000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Richard Finn 050848
Lot Size(sq ft.): 12632.40 Owner: DOSTAL JAMES M&NANCY L
Zoning: SR Applicant: Richard Finn
AT: 624 RYAN RD
Applicant Address: Phone: Insurance:
29 Hickory Drive (413) 584-4172
FLORENCE 01062 ISSUED ON.•10119/1999 0:00:00
TO PERFORM THE FOLLOWING WORK.-SHINGLE ROOF OVER EXISTING 1 LAYER
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 10/19/1999 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo