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PERMIT APPLICATION CHECK LIST
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1 . Zoning Form Application
2. Permit Application f/
3. Homeowner statement if a licable Lic. ## if not
4. 2 sets of tan C-C c h tom'
5. Curb cut ------
6 Water Deoartm mPmn
At'7 Permit fee - check only ,r- .-z-j -� 461• �a
$ Special Permit required with deed if a plicable
9. section 1 27 -
Form A
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DEPARTMENT OF BUILDING INSPECTIONS
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INSPECTOR 212 Alain Street ' Municipal Building
Northampton, Mass. 01060
AS A HOMEOWNER I UNDERSTAND THAT I MAY APPLY FOR AND RECEIVE
A BUILDING PERMIT FOR A HOME OR ADDITION I INTEND TO LIVE IN.
I ALSO UNDERSTAND THAT I AM RESPONSIBLE FOR KNOWING THE STATE
BUILDING CODE AND ZONING ORDINANCE OF THE CITY OF NORTHAMPTON.
BEING A HOMEOWNER 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.
Signature & Date
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Date Filed File No. 2,9_ '-Q-99
ZONING PERMIT APPLICATION (510.2) U R A
1. Name of Applicant: �` M
Address: C t {. Telephone:
2 . Owner of Property:
Address: Telephone: ` k 7",
3 . Status of Applicant: V/Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# Parcel#
Zoning District(s) (include overlays)
Street Address
Required
5 . Existing Proposed by Zoning
Use of Structure/Property art0wm 4Zg1V a cL
(if project is only interior work, skip to #6)
Building height
%B1dg.Coverage (Footprint) ,/
Setbacks - front ,r —�
- side /67 IsY
- rear /
Lot size Zp S-R
Frontage o
Floor Area Ratio
%Open Space (Lot area minus
building and aE rking) Z,S cit.
Parking Spaces
Loading
Signs
Fill (volume & location)
6. Narrative Description of Proposed Work/Project: (Use additional sheets
if necessary) 82QeV&L -1?/ f.)Q.W-A(6 D£Ctc
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: S ����� Applicant's Signature:
- - — — — — — '- - =
THIS SECTION FOR OFFICIAL USE ONLY:
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// Approved as presented/based on information presented LJ
Denied as esented
as for n' 1:
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ignat f BuiAnit ldin�Inspector Date
NOTE: Issuance of a zonin" not relieve an Iicarrt s burden to cam with all zoning requirements and obtain all required permits
9 aPP PN
from the Board of Health,Conservation Commission,Department of Public Works and other applicable permit granting authorities.