29-262 APPLICATION PERMIT CHECK LIST
PAG 1 • DATE
. ���
A, 3 SETS OF PLANS /PLOT PLAN
5 . NEW CONSTRUCTION
6 , CURB CUT
WATER FORMS --
-:
9 . ADDITION
_ . : _
12 , PERMIT FE M2NLY MONEY ORDER
13 , SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
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-FORM 14 . UNDER SECTION 127 --- CMR 780
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
1 Garage
1. Location ` oa ul Lot No.
2. Owner's name 441 -f ik&uh Address �L C U` ���Q-0 Q"-e— t-ency
3. Builder's name Lk YMCU4 t 0AQ.4,i0C0a-y Rt4ju } 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 n No.of cars Size
10. Method of heating �,k )
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
s
Signature of responsible app,icant
Remarks
00344E
a Date Filed File No.
ZONING PERMIT APPLICATION (§10.2)
1. Name of Ap licant: ALPvo + �Xbom iALQ
Address: �•r�G�,n«1 �i t� "uti (.Q Telephone: 4j -S (
2 . Owner of Property: QqZ wz+) 0'd °5
Address: Telephone:
3 . Status of Applicant:/Owner Contract Purchaser
Lessee Other (explain: )
4. Parcel Identification: Zoning Map Sheet# .,19 Parcel# -,'2 e a,
Zoning District(s) (includ erlays) _ �e
Street Address
Required
5. Existinq Proposed by Zoning
Use of Structure/Property - �
(if project is only interior work, skip to #6)
Building height
%Bldg.Coverage (Footprint)
Setbacks - front
- side
- 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)_Lt XxYt L`�kUe- (/V !► ,�-
1. 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: � I/,3f j`� Applicant's Signature: L,21 'A Q U
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
ZApproved THIS SECTION FOR OFFICIAL USE ONLY:
as resented based on information resented
P / P
Denied as presented
R s 'for a-vial:
igna , of �d-ing-Inspector �� at
NOTE: Issuance of a zoning permit does not relieve an applicants burden to comply with all zoning requirements and obtain all required permits
from the Board of Heakh,Conservamon Commission,Depadmert of Public Works and other applicable permit granting authorities.
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