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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 Lot No.
2. Owt s name Address
3. Builder's name 1i Address
Mass.Construction Supervisor's License No. -5 C� 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 COSL-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
SkjnAre of responsrbke/app,tcani
Remarks
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. ��-�- Tel.No. b�s 7°�Q3� Alterations
NORTHAMPTON, MASS. [:Gj4 19Jz Additions
APPLICATION FOR PERMIT TO ALTER Repair
// Garage
1. Location Lot No.
2. Owner's name o `� Gr c/1 / Address 3' /fj cc�fc���/7f♦ ����lIG�'
3. Builder's name /�� c����rS / Address I /5'
Mass.Construction Supervisor's License No. li t�r�'7-5"C7 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- rjrOG
The undersigned certifies that the above statements a true to the best of his, her
knowledge and belief.
�=y
Signature of respon a app scant
Remarks
io. Do any signs exist on the property? YES NO
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES NO D'
IF YES, describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This colt to be f111ed in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - front
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
# .of "Parking Spaces
of Loading Docks
Fill:
Avol-rime--& location)
13 . Certification: I hereby certify that the .information contained herein
�f is true and accurate to the best of my knowledge.
DATE:
: APPLICANT's SIGNATURE PC NOTE: lasuanoe of as zoning permit does not relieve an applicant's bur en to mply-with,all
z®ning requirements and obtain all required permits from the Board of Health. Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
l
File No C �
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of
Address:S' 1157 z �/� / �t. ���1`Telephone: .Sr� 9.3
2. Owner of Property:
Address:_ � � �' /l'�ifh'1,a/��'i elephone: -3��
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: f�
Parcel Id: Zoning Map#�' Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property � Ll
6. Description of Proposed Use/Work/Project/OgAupation: (Use dditional sheets if necessary):
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special Permit/Vadance/Finding ever been issued for/on the site?
NO DON'T KNOW 4- YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO -y DON'T KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained date issued:
(FORM CONTINUES ON OTHER SIDE)
FILE I i q
APPLICANT/CONTACT PERSON:
ADDRESS/PHONE: ' 7
n � j
PROPERTY LOCATION: r 1
MAP PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERNIIT APPLICATION CHECKLIST
ENCLO ED REQUIRED DATE
70NING FORM EMLED OUT
Fee Pnid
Fp�, Paid (1 ,:)r,
ArregynryStrivChire
THE LLOWING ACTION HAS BEEN TARN ON THIS AP ICATION: '.
Approved as presented/based on information presented
Denied as presented:
Special Permit and/or Site Plan Required under:§
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under:§ w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval-Bd of Health Well Water Potability-Bd Health
!Permit ff Co el vati in
Signature of Building Inspect at
NOTE:lssuanoe of a zoning permit does not relieve an applicant's burden to comply with all
zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authorities. —
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