29-132 (4) PERMIT APPLICATION CHECK LIST
PAGE 2— PLOT F-32-- ZONE U-P-'� YES NO DATE
1 . ZONING FORMAPPLICATION Z- Z
2 . PERMIT P LIC TIO
3 . OWNER OCCUPANT STATEMENT LIC # IF NO
4 . 3 SETS OF.-PLANS 0 PLAN
5 . NEW CONSTRUCTION
6 . CURB CUT
7 , WATER LABI I FORMS
8 . REMODELING INTERIOR
9 , ADDITION
10 . ACCESSORY STRUCTURE
1 , SIGN AWNING
12 . PERMIT FEE - CHECK ONLY - MONEY 0 DER Utt tt t- t o
�QIUQ.t<
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 , FORM A
16 FILL —
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations li> '04�0IUOOkyI
NORTHAMPTON, MASS. �? �1.,! 43 b 19_/�J Additions
l 1
APPLICATION FOR PERMIT TO ALTER Repair
Garage
I. Location (�Q/ ��.• /Q/c KJ✓V G 2 i I Lot No.
2. Owner's name D Z jAis- 1A Address a 6 <;al.0,5 P
3. Builder's name °�ftJy►'1 �!�U,Sr>.� Address
Mass.Construction Supervisor's License No. 6 D,,2 d Expiration Date
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
14. Estimated cost4�'9164 do
The undersigned certifies that the above statements are true to the best of his, her
VV knowledge and belief.
Signature of responsible app<<can!
Remarks r' /�Y7 /g4V� 0/� �/Ci W �/ �!J ✓J /��
,4 �. G O V 5A w�Vt� 1 5 tic J
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'Datef Filed 00096
File No.
ZONING PERMIT APPLICATION (§10. 2)
1. Name of Applicant: imps E w-t,
Address : .y(�, 6c�s�r Telephone: J- /6,
C>104,0
2 . Owner of Propert
Address : ,2L (1,* V
--CS Telephone:
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# Parcel# l3 Zr
Zoning District (s) (include overlay
Street Address
Required
5. Existi Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
- side L: R: L: R:
- rear
Lot size
Frontage
Floor Area Ratio
%Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6 . Narrative Descriptio of Prop sed Work/,Pro ect: (Use additional sheets
if necessary)
7 . Attached Plans : Sketch Plan Site Plan
8 . Certification: I hereby certify that the information conta ' ed herein
is true and accurate to the best of my knowledge..
Date: � App1i cant IsSignature:
/ THIS SECTION FOR OFFICIAL USE ONLY:
//Approved as presented/based on information presented
Denied as presented--Reason:
pecial Permit and/or Site Plan Required:
ding ired: Variance, Required: _
igna u e of Build ' nspector
NOTE: Issuance o oning 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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