29-424 (4) �` PERMIT APPLICATION CHECK LIST
AGE PLOT 7• ,� ZONE 0 ES NO DATE
C e� .
ZONING FORM APPLICATION II r
2 . -PER-MIT I
3 OW O
3 S9T-S OF PLANS /PLOT PLAN
5 . NEW CONSTRUCTION
6 . CURB CUT
7 w TE
8 . REMODELING
9 . ADDITION
0 . ACCESSORY UC
11 . SIGN / AWNING
2 , PERMIT FEE - CHECK ONLY - MONEY 0 DER.,
3 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
4 . UNDER SECTION - 127 - QMR 780
FORM A
6 . FILL
COMMENTS:
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
/ Garage
1. Location tea 6 c,I&AJ i��- , Lot No.
2. Owner's name n k W,p '.l U4 f" &,' SA A Address 6 o Id c&
3. Builder's name `T 11( .,-) i Address G 1
Mass.Construction Supervisor's License No. b 11 Expiration Date U 3Z/ci r
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 L
12. Type of roof /+° ��lto � v1�4 .�r1 — �'Au CJ a
13. Siding house
14. Estimated cost:- if O0
The undersigned certifies that the above statemcnts are true to the b ";of tris, her
knowledge and belief.
nature of responsible app ican1
Remarks
Date Filed File No.
ZONING PERMIT APPLICATION (§1.0. 2)
I. Name of App 'cant: .
Address:- r`,v/. f4-49 Telephone:
2. ' 'Owner of Property: C—b�p a 00
Address: Ue
T61ephone:
3 . Status of Applicant: Owner ✓Contract Purchaser
Lessee Other (explain GG )
4 . Parcel Identification: Zoning Map Sheet# I Parcel#_q�7
Zoning District(s) (include- 0 1
street Address 5-5 clays
Required
5. Existin -Pro Dosed by Zoning
Use of Structure/Property
(if project is only, interior work, sk to )
Building height
%Bldg. Coverage (Footprint)
Setbacks - front
- side L: R: L:
- rear
Lot size
Frontage.
Floor Area Ratio
oOpen 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: /U„ - ;4?� 7-42 Applicantrs Signature:
- — — — — — — — — — - - — — — —
.�
THIS SECTION FOR OFFICIAL USE ONLY:
_, Approved as presented/based on information presented
Denied as presented--Reason:
S ecial*' Permit and/or Site Plan Required:
and g Re jd: Variance Required:
oc�ignatu" f Bu�.ldin or ` r to
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NOTE: issuance of a zoning permit does not rettove an applicant's burden to comply wills all zoning requirements and obtain all required permits
from the Board of Hoallh,Consarvadon Commission, oopwtmont of Public Works and otlior appiicablo permit granting authorities,
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