11A-072 (2) l"7 Leo ria-r-c( c31- Le td S PERMIT APPLICATION CHECK LIST
PAGE I I f\ PLOT o'7a. ZONE L.RA YES NO DATE
1 . ZONING FORM APPLICATION G"fa. � � .
2 . PERMIT APPLICATION
3 . OWNER OCCUPANT STATEMENT / LIC.# IF NOT !i
4. 3 SETS OF PLANS /PLOT PLAN
5 . NEW CONSTRUCTION
6 . CURB CUT
J . WATER AVAILABILITY FORMS
8. REMODELING INTERIOR
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 . SIGN / AWNING
4''40.00 �ertL . �k. MC�J
12 . PERMIT FEE - CHECK ONLY - MONEY ORDER
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 . FORM A
16 . FILL
COMMENTS: =-nteriolr C� + y
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DEPARTMENT OP BUILDING INSPECTIONS i-
INSPECTOR 212 Main Street • Municipal Building ',,,M=ss e.>e
Francis X. Sienkiewicz
Northampton, Mass. 01060 s,
HOMEOWNER OCCUPANT STATEMENT
AS A HOMEOWNER OCCUPANT I UNDERSTAND THAT I MAY APPLY
FOR AND RECEIVE A BUILDING PERMIT FOR A HOME OR ADDITION
THAT I INTEND TO LIVE IN.
I ALSO UNDERSTAND THAT I AM RESPONSIBLE FOR KNOWING THE
STATE BUILDING CODE CMR 780 AND ZONING ORDINANCE OF THE
CITY OF NORTHAMPTON.
BEING A HOMEOWNER OCCUPANT AND NOT A PROFESSIONAL
CONTRACTOR IN NO WAY ABSOLVES ME OF ANY RESPONSIBILITY TO
INSURE THAT ALL FACETS OF THE RULES AND REGULATIONS ARE
COMPLIED WITH. I AM AWARE OF MY RESPONSIBILITY TO
COMPENSATE WORKMEN FOR ANY WORK RELATED INJURIES THAT
OCCUR ON THIS WORK SITE IF NOT INSURED.1 61 .X.: 1.
SI�A i d RE DATE
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
g�as '".,. NORTHAMPTON, MASS. 19 Additions
a" ':A; Repair
`' ?.`.e APPLICATION FOR PERMIT TO ALTER
e / Garage
1. Location /74E0/,,t4 5// Z- )� /4 Lot No.
2. Owner's name `7-1-t0 7 1 e71 -1/ Address /7 `///¢ie� Cr' L'j� ,
3. Builder's name // Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
i
5. Alteration f'-200-rf /< oZ-s4
6. New Porch
7. Is existing building to be demolished? //
8. Repair after the fire ArO
9. Garage No.of cars Size
10. Method of heating "�of
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost:-(9,00 ' -12-1`
The undersigned certifies that the above statements are true to the best of his, her
knowled b li .
Signature of responsible applicant
Remarks
PHI•YNYT#TSHOP
,. H F r .
Date Filed If I)- Q �- i
File No. ( - O7 ,
ZONING PERMIT APPLICATION (§10 . 2 ) U_.RA
1 . Name of Applicant : '-3 7 AO ' tj
Address : £G ,.y<. , _ 41-5o Telephone: sPACVNIV
2 . Owner of Property :
r4
Address : Telephone:
3 . Status of Applicant : Owner Contract Purchaser
Lessee Other (explain )
4 . Parcel Identification: Zoning Map Sheet# i l k Parcel# oq7 D,,
Zoning District (s) (inc lud9 oM _ (--A R A
Street Address .tf •
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
- rear
Lot size
Frontage
Floor Area Ratio
%Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6 . Narrative Descr�p tion of Proposed Work/Project: (Use additional sheets
if necessary) jC maA.rG Zi $ Gr-7 'i 5 , ,4 f
NEB
7 . Attached Plans : Sketch Plan Site Plan
8 . Certification : I hereby certify that the information contained herein
is tru an accurate to the best of my knowledge.
(' 41 r
Date . Applicant s Signature. +/,
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THIS SECTION FOR OFFICIAL USE ONLY:'.`
� / . 1 2
h'' Approved as presented/based on information presented
Denied as p -esented
asop forn 'al :
4g! -natu�
oBui i nspector D to
•
NOTE: Issuance of a zoning permit dons not relieve an applicant's burden to comply with all zoning roquiromonts and obtain all required permits
from the Board of Hearth, Conservation Commission, Dopartrnont of Public Works and othor applicable permit granting authorities.
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