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Gl its of &Xoz:t4smpton M -
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' DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building M
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.
i nature & Date
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. c� Alterations v
go NORTHAMPTON, MASS. -3 1 -7 19 / � Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location -2- 6,,4 n A Lot No.
2. Owner's name &44 R I� �� L' Address 27- 671 Z- t?,4 7—e/Zrl�V E . FLU /lf'.z
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration ,��T¢/r 'OQ�''I { ,r ai�4F l ,9 S � ti'T.
6. New Porch
7. Is existing building to be demolished? Ot,16)
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 cost:-
y U Q U The undersigned certifies that the above statements are true to the best of his, her
edge and belief.
Signature of responsible applicant
Remarks
PHIN, T±SHOP
.y
PERMIT APPLICATION CHECK LIST
Yes No Date
1 . Zoning Form Application
2, Permit Application
3, Homeowner statement if a licable Lic , # if not
A, 2 sets of Qlan5 e7, K c Cc6"�
5. Curb cut
6. Water QeR- rtment,
7 Permit fee - check only '�
8, Special Permit_rf4ui red yrith -O-eje
9, Under section 12Z CMR 780
Form A
Date Filed ' Iq
20N1 NG PERJ141T APPLICATION (,)10 , 2 )
J. , Name ;of Applicant : /tT 0 d2 d? I',5
Addr,csss l .. 7 Telephone 1 '„ - C� _
.. 2 , - owner of Property !
Address ; �c Telephone 1 C �
3 , �St,atus 'of Al�plioant ; t� o�rner Oontract Pgrohaser
Lessee other. (explain; �� )
4 , Parcel Identification : zoning 14ap Sheet// �_Cl arc:G:l,Y 6
2onSrlcj D�.strict (s) ( in;clude overlays) uR�.1 �
St.raet Address T _ ......_.....
• Rl�cl1i i.
5 , 1,x 9gtincy proposed
Use of. Structure/Propert•y tk,-2
(if• project 'is only intarioF work, skip Ito G )
R3uildiliy height �»
,• kp].dg , coverage (F'ootprlilt) _
$et Yiacks - i~ront
s idd ._._�._
rear
Lo't' s i z e
F oar, Area Ratio
k0pon Space (Lot 4rea 'minus
1xr.i'7:d.i�?c� 4nd paz•k.iny)
�ax)cinc� .spaces �_....._...... ...
Signs
'• ' , I`i1;t (vo.Iu,nro fc locst.ion) T �--.;._. �+'".
L
6; Narrat iVe Des'oription• of Pro pled Work/Pr.ojGet; se additior��,:l. , :fac-ts
' . . X�' 1F�ossary) � � �• 2
ti ..._..
7 Attached Plans ; Sketch Plan ,sit•e Pl'a.n
8 Caxtificationl ,T ' hereby eertify •ghat: the info ation oont•uinecl hL.- e,in
i'i true and Accurate to the best of my knowl dg ,
Date t � � ( 7- � "�-- Applicant, I•s Signature :
•. -- "rl'Hx8 SECTION FOR OPPICIAL• UBE OnYl
, •1
G Approved as '13rese;ited/based on infor'lnat'ion' presented
DeR�ied as presented .
R son i'o Denial
xnatu a au c ng Inspe.ctor bate .�-..__ _..
NOTE; lN UMN of a zonlnp,pormll dojo nol tollwo an appUount's burclon to cotnpF wlUi all zonlnp rogttlturnont*s and otltalrl a!l ,,quilL•j r
froth Iho Uard.o(Honhh, Concorvagon Cornmloolon, (3opalnI0111 of pvbilo 1Votka and oUior appllcabrq--pt mt avdtnrfp
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