16A-020 / PERMIT APPLICATION CHECK LIST
PAGE /6 11 PLOT d ZONE u ' ` q (J4 . YES NO DATE
1. ZONING FORM APPLICATION C/* 1 '/I !?2
2. PERMIT APPLICATION
3. OWNER OCCUPANT STATEMENT / LIC. IF NOT L/
4. 3 SETS OF PLANS /PLOT PLAN
5. NEW CONSTRUCTION
6. CURB CUT
7. WATER AVAILABILITY FORMS
8. REMODELING INTERIOR
9. ADDITION Fh
1
10. ACCESSORY STRUCTURE
11. SIGN / AWNING'
12. PERMIT FEE - IbFiEc ONLY - MONEY ORDER 41 1-16
13. SPECIAL PERMIT REQUIRED WIT}t DEED IF APPLICABLE
14. UNDER SECTION 127' - CMR 780
15. FORM A ��
16. FILL !
COMMENTS: 1'
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Date Filed File No.
ZONING PERMIT APPLICATION ( §10.2)
1. Name of Applicant: \ Ny,�Q '�.�
Address: ct-1. o , L � uosc 4, ‘,A Telephone: s a'7 `73x'7
2. Owner of Property: ft,.Y,c1R.1cte_ ,la s
Address:lam - Icl y , , -4. Telephone: 'Sttl --j
3. Status ° of Applicant: Owner Contract Purchaser
Lessee Other (explain: eon .n-/Rzc aTy
4. Parcel Identification: Zoning Map Sheet# , , Parcel# Gi ,
'Zoning District (s) (include ovezlays �,( ''�l/�
Street Address .4/11
— � '�L(Iucc, i .
Required
— 5. = Existing Proposed by Zoning
Use of Structure /Property
(if project is only interior work, skip to #6)
Building height
%Bldg. Coverage (Footprint\
Setbacks - front
side T L R
- rear
Lot size
Frontage
Flodr Area Ratio
%Opg�nn Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6. Narrative Description of Proposed Work /Project: (Use additional sheets
if necessary)
7. Attached Plans: Sketch Plan Site Plan
8. Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
Date: v 1. c�,`7 1 �� a A pplicant's Signature
1
THIS SECTION FOR OFFICIAL USE ONLY:
p as presented /based on information presented
Denied as presented
. son for J-nial:
Age // -kr!
gnat r- of Buil• '••- Inspector ate
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits
from the Board of Health, Conservation Commission, Department of Public Works and other applicable permit granting authorities.
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Zoning
Miscellaneous Additions, Repairs, Alterations, etc. Tel. No. S4 `i - t 3 14 "c Alterations t c 6se,M, t,
�"""` , NORTHAMPTON, MASS. - ..\ .) `' , c - 1 19 ma Additions
"'' Repair
'` APPLICATION FOR PERMIT TO ALTER Garage
1. Location l-1 \ `1 <, .. c t.>.) A •,., V , R H e- Lot No.
2. Owner's name - cn . � a KL, G t'L 4 v-v% -2 Address ) -4 k c't � 4 , cZ n -..` 01 \ IA `71-t, ll
3. Builder's name % w, c I L A . \ _ Address .G `&— h.I c h.\ `,∎%. )'t_e, -t cz.� - We.s- L h-t,q -a tiv
Mass. Construction Supervisor's License No. 0 1�1 rl Expiration Date G i.:10 I ° 3
tic c m .,r.. A.-k4. -LS Ai. i U (s 3 0 (0)3.6/ 9 Li
4. Addition
5. Alteration -S,v \'. �A`��. - Y - Y �'
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
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
knowled i .ilief. tr
I g/ Sig ature of respons ble applicant
Remarks
PNIN taSHOP
Sc6G co A
-:�t� City of Northampton REQUIRED INSPECTIONS
� # 1. Footings and Walls
(ri
' BUILDING DEPARTMENT 2 • Structural Components in ■
Place
• 3 . Complete Building
No. 491 Office of the Building Inspector
Date July 28, 1992 19
THIS MAY CERTIFY THAT Fredrick Ames /Timothy Daley Insp. on Site — Foundations
has permission to Finish basement, frame 2 walls, build clos Insp. of Plumbing — Rough
situated on 419 Fairway village Insp. of Plumbing — Finish
provided . that the person accepting this permit shall in every re- Insp. of Wiring — Rough 7 - ? � ' 1 _
spect conform to the terms of the application on file in this office, -
and to the provisions of the Statutes and the Ordinances relating Insp. of Wiring — Finish 6 / r e -2 / -so. )e - L)
to the Construction, Maintenance and Inspection of Buildings in Insp. of Health (Septic Tanks) /
the City of Northampton. Any violation of any of the terms above _ _ , ---,-/-
noted is an immediate revocation of this permit. Expires six Building Insp. — Rough 'z�., - ---
months from date of issuance, it not started. Building Insp. — Finish G ` � '��
Note: A certificate of occupancy will be issued by this office upon r
return of this card signed by the Plumbing, Wiring and Building Smoke Detectors (Fire Dept.)
Inspectors. Gas Inspection
THIS CARD MUST BE ,DISPLAYED IN A CONSPI OUS P .4 E ON THE PREMISES
Certificate of Occupancy
iz�
,.$:•- ring Inspector