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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. n- Alterations �IleilcCcn_
NORTHAMPTON, MASS. :1)1W to 19L Additions
�• Repair
• ' APPLICATION FOR PERMIT TO ALTER
Garage
1. Location 2 Lk C2 ran&tjuo 4)k- • Lot No.
2. Owner's name `. Cl ( x e -t 1 art a Ca J r Address Zy L,,nL.v►cA\/i&L) vS+. r;I(yt4-)c-e-
3. Builder's name C.-\I Y 6 N ei j-.)MGL*-) Address
Mass.Construction Supervisor's License No. f7l dLlloolC Expiration gate L1 1 Q'ok
4. Addition
5. Alteration A4Y-i — A-Y-^, (Xo r AQ [x �F 1 K et,
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 ' ` kl1t
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible app,icant
Remarks
JUL 6 i9q"
(ritR of Narfjanipton
.�lifiRrhicfrtlII r
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
ttil �>
with a principal place of business/residence at:
LA3 V (phone#) o-ICq-S
(t;t MUCity/st Mip)
do hereby certify, under the pains and penalties of perjury, that:
(� I am an employer pro�rding the following worker's compensation coverage for my
employees working on this job:
GJJa,-A ,.ns CA-)- �r k� t, qV ,Ct a 'A 1999-
(kwirance Company) (Policy Number) (Ex lion Daze)
( ) I am a sole proprietor, general oontractor 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 ComparlyiPohcy Number) (Expiration Dare)
(Name of Comractor) (las rance Company/Poticy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(atraeh additiotssl sheet if neocasry to include information pertaining to all contrae rs)
( ) I am a sole proprietor and have no one woriang for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that wWo homcowosss wbo ca*oy petroas to do m*=U sx we�oomt%ucuoe or repair wort:oa a dwelling of
not more than throe units in Which the honiow as resides or on the grouoda spWrlta d lherda acs not gaoetally considered to be
employers under the wodwft oompcusstion Act 1(5)),application by a homeowner for a 6==or permit may-idcvoe tho
legal status of an employer under thn Workmes cowpeoastion Act
1 uaderstsatt Hat a copy of this ctatem act maybe forwerded to the Doportmeat of la d', al A=4e a&Offioc of lusun rce Tor Hie
coverage verification and that failure to aeacre coverxgo under saxioa 25A of MaL 152 can lead to tW imposition of criminal penalties
oomutiag of a fine of up to$1,500-00 andlor ompruos>MCut of up to one year and civil penalties in the form of a.Slop Work Order and a
fm of Sioo.00 a day against tae.
Signed this_b_da
gn y of 8 for W use only
Permit Number
Map#.T - — Lot#
Si of--iccnseee1Permuttee
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 colt to be filled in
by the Bniiding Department
I 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
' &paged parking]
# of "Parking Spaces
# of Loading Docks
Fill:
(vol-lime--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
_1
DATE: zh A F_ APPLICANT's SIGNATURE L/
NOTE: lase noe of a zoning permit does not relieve an a 1 ant's burden to oom
PP Ply.wit4,,4klt
zoning requirements and obtain all required permits from We Board of Health, Conservtstion
Commisslon, Department of Publio Works and other applioable permit granting authorities.
FILE #
JUL 6 1'99 ,
3
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:--2;�Address: ' 7 1 ' Telephone:
2. Owner of Property: N I c?-
Address: y 12�v�li;�' u� � 'Cj Telephone:
3. Status of Applicant: Owner _Contract Purchaser Lessee
Other(explain):
4. Job Location: a L( V2 c;c,^'�3
Parcel Id: Zoning Map# 74 Parcel# 93 District(s): �(
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property NI "r
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
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 KN0V%' 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)
Reference No: BP-1999-0013
Department: ...................................
Building,Electrical &Mechanical Permits
... .....................................................................................
Fee Type: Receipt No:
Roofing REC-1999-000019
..........................•.............................................................. ......................................
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 24 GRANDVIEW 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-1999-0013 $20.00
GIS#: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
1403 17A 093 001 24 GRANDVIEW ST URA 11630.52
Contractor: License Type: Insurance:
Cyrus Newman CSL Workers Compensation
Address: License No.: Insurance No.:
697 Bridge Road 064690 NEWC913927
City: State: Zip Code: Phone:
NORTHAMPTON MA 01060 (413) 586-1093
Protect No: Catesoryof Work: Const. Class: Cost Estimate:
JS-1999-0021 $2,000.00
Description of Work:
strip & shingle roof
GeoTMSO 1997 Des Lauriers&Associates.Inc. Cvana+..rP-