29-214 (7) ti
PERMIT APPLICATION CHECK LIST
PAGE SCI PLOT �tl ZONE tkk4" 1, `"� ' J YES NO DATE
1 . ZONING FORM APPLICATION 12-11
2 , PERMIT APPLICATION
3 , OWNER OCCUPANT STATEMENT / LIC # IF NOT
4 . 3 SETS OF PLANS /PLOT PLAN
5 . NEW CONSTRUCTION
6 , CURB CUT
7 . WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 . ADDITION
1.0 . ACCESSORY STRUCTURE
11 . SIGN / AWNING
1 2 . PERMIT FEE- - CHECK ONLY - MONEY ORDER
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 , FORM A
16 . FILL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No._ Alterations
a NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Re p air
Garage
1. Location f f y a k e /�o o _ Lot No.
2. Owner's name / �A hd c Address___ %1�I n(!y., &00
3. Builder's name G. �" &A 7lno► Address /'
Mass.Construction Supervisor's License No. 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 cost:- 6 '9 O
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible appicani
Remarks
f
w 4rriy, y
Date Filed
File No.
ZONING PERMIT APPLICATION (§10 . 2)
I. Name of Applicant:
Address : Telephone:
2 . Owner of Property: .
Address : Telephone:
3 . Status of Applicant: owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet#?il Parcel#
Zoning District(s) (include ove lays)_ U,, 0-
Street Address
Required
5. Existing Pro nosed 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:
- rear
Lot size
Frontage
Floor Area Ratio
%Open 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)
1�
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: Applicant's Signature:
THIS SECTION FOR OFFICIAL USE ONLY:
!/Approved as presented/based on information presented
Denied as presented--Reason:
Special' Permit and/or Site Plan Required:
,,/,, finding Req are(P. Variaric Required:
S gnature u:P��ding or ` Date
NOTE: Issuance of a zoning, ,
g oes not roliov e 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 nuihorilios.
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