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17C-011 (3) a > z 3 �s OZ m O Z p W t=7 O X a Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MASS. [' 10 .q 19_qa Additions APPLICa ATION FOR PERMIT TO ALTER Repair Garage 1. Location 2-u Lag Q R &,jNxe , Mck 0 i0to 7 Lot No. 2. Owner's name /1QrN Address �'`� L❑X� �1�1'�iYt� 3. Builder's name l_ t rt) �°C1�)rnl��� Address-aa} RYi CA CaP r't_ Mass.Construction Supervisor's License No. LQY 1 o q® Expiration Date 4 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 Q (C Q {.✓i e I VAS C, (Aaf 5 k 42 13. Siding house 14. Estimated cost- The undersigned certifies that the a e statements are we to the best of his, her 2 . knowledge and belief. -� i Signature of responsible app,icanr Remarks �hANp B �lassarilasetta FEB 1 01999 _ DEPARTMENT OF BUILDING INSPEcTIONs 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFk30DAVIT L Ci�5 .t-A n-'a,C, with a principal place of business/residence at: A4 f�_.LA — (phone#)�� (stMWCity/statehip) do hereby certify, under the p?ins and penalties of perjury, that: 00 I am an employer providing the following worker's compensation coverage for my employees working on this job: GXL'A • _ �1 tw C q _ MOAA 1 a� (Insurance Company) (Policy Number) Sion 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 Dale) (Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date) (attach additioml shed iftia=2 ty to include information peruiniag to all ooe4wion) ( } I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:pltxae be aware that while homoowmera who employ peso=to do am4wenaaa cousmaioa or repair work on a dwelling of not more than three units in which the b o meow=ro idea or 00 the grounds appurtemwl thetdo ace not gtmeralty oocsWered to be to Playas under tba wurimt cm persatim Act(GL152.=1(5)�application by a homeow=for a liansG or permit may evide=the 4621 otatua of as employer under the Workeea Compamatiou Ant I uodetstaa4 dub a OWY of this statemam may be forwarded to the pepu%nu t of laduitrial Aecidentf 096oa of Lrauranco for the coverage vetificatioa lead that failure to Beaus coverage tauter section 25A of MOL 152 can lead to that impo%Woa of txiaii peatWes 000siatimg of a fine of up to SI,500.00 tatdor l of up to one year sad civil pentWes in the form of a Stop Work order and a faro of 5100.00 a day against ma Signed this day of 1991 Ford xtuseoory Permit Number Si Map# Lot# Liccnsee/Pcrmitt= 10. Do any signs ebst 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 —1— to be filled in by the Building Department Required Existing Proposed By Zoning Lot size Frontage Setbacks - side L: R: L: R: - rear Building height Bldg Square footage %Open Space: (Lot area minus bldg &paved parkzngli # of Parking spaces f of Loading Docks Fill: (vol-ume--& location) 13 . Certification: I hereby certify that the information contained herein is true nd accurate to the best of my knowledge. D24'1'E: APPLICANT's SIGNATURE NOTE: Issu ® f a zoning permit does not relieve an app ant's burden to oomply wit4 ,all zoning req i aments and obtain all required permits from lye Board of Health, Conservation Commission, Department of Publio Works and other applioable permit granting authorities. FILE # FEB 1 01999 m0 I q6 k� File No. ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of,Applicant: f n Address: l o(�"f a C CP rid . Telephoner 2. Owner of Property: LQ:�12 140e-&4 Address: Z-� LWL C� . Telephone: 3. Status of Applicant: Owner Contract Purchaser Lessee _Other(explain): 4. Job Location: Z. y L, 'X . j1 6:E, Cj(��iVl( P Parcel Id: Zoning Map# Parcel# District(s): (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property g.,,a h 2: p 6. Description of Proposed Use/Work/Project/Occupabon: (Use additional sheets if necessary): t_ rnc--� j jl, od Q r e ni r�o j►)�kLh Qd's-n d a _ 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/Vadance/Finding ever been issued for/on the site? NO DON'T KNOItir�_ 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) 2 LAKE ST BP-1999-0686 CIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:Iit 1 '1t ",�o CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: roofing BUILDING PERMIT Permit# BP-1999-0686 Project# JS-1999-1273 Est. Cost: $3500.00 Fee: $20.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use croup: Cyrus Newman 064690 Lot Size(sq. ft.): 12283.92 Owner: HARDY DANIEL R zoning: URB Applicant: Cyrus Newman AT. 2 LAKE ST Applicant Address: Phone: Insurance: 697 Bride Road (413) 586-1093 Workers Compensation NORTHAMPTON 01060 ISSUED ON.•2110199 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF 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 2/10/99 0:00:00 $20.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo