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PERMIT APPLY ATION CHECK LIST `*
PAGE PLOT aU ZONE , J ES NO DATE
1 . ZONING FORM APPLICATION �-- Q
2 . PERMIT I
3 . OW 0 L
3 SETS OF S PLAN
5 . NEW CONSTRUCTION
6 . CURB OUT
7 . WATER S
8 , REMODELING
9 . ADDITION
0 , ACCESSORY
11 . SIGN / AWNING
2 , PERMTT FEE - CHECK ONLY - MONEY ORDER �-
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 7 - C R 780
15 , FORM A
6 , FILL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. = ;t,0 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
/1 Garage
1. Location N s �-•9 5 t �/a.!'. nl i'J '�-` Lot No.
2. Owner's name 7�� ti v B 2 t,13 Address_--, °'s� c�r�s c-mil S j �'/v/1 c.L Il-�}
3. Builder's name 73 Address " su 9'e , V,, �' "~ T �'✓'�
Mass.Construction Supervisor's License No. OA t 19'V4- Expiration Date_ 0; /37 y�
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
13. Siding house ✓/l it X 4 a C;
14. Estimated cost:- �
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signa1u 1 responsible appicam
Remarks
l
t �
Date Filed File No.
ZONING PERMIT APPLICATION (§].0. 2)
1 Name of Applicant: L.
Address : 7�� t��� �? - f� ,�7LA� c x) Telephone: ski /1 7
( 2� Owner of Property: a��; s��.�u
Address : �-3 Telephone:'
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain )
4 . Parcel Identification: Zoning Map Sheet# Parcel# MP,
Zoning District(s) (include erlays)
Street Address 53 P14\
Required
5. Existincr Pro nosed —by Zonin
Use of Structure/Property
(if project is only- interior workp sUcip o 6)
Building height
oB1dg . Coverage (Footprint)
Setbacks - front
- side L: R: L:
rear
Lot size
FrontacA_ .
Floor Area Ratio
oopen Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume 4 location)
5 . Narrative Description of Proposed Work/Project: (Use additional sheets
if necessary)
Y IV
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: )2-- Applicant
r s
THIS SECTION FOR OFFICIAL USE ONLY:
Approved as presented/based on information presented
Denied as presented--Reason:
Spe �'al' Permit and/or Site Plan Required:
-riding Requir Variance Required:
si,Tg'na ure df ding Insp r \1 Datd l-=
NOTE: Issuance of a zoning permit does not rellove an applicant's burden to comply with all zoning roquiroments and obtain all required pormits
from tho Board of Health,conservation Commission, Doponment of Pubi(c Works and other applicable permit granting outhoritios.
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