35-214 (2) Ali , u>
PERMIT APPLICATION CHECK LIST
PAGE PLOT ZONE Cyr ��� �'yK , YES NO SATE
1 . ZONING FORM APPLICATION
2 . PERMIT APPLICATION
3 . OWNER OCCUPANT STATEMENT LIC . # IF NOT v
4 . 3 SETS OF PLANS OT PL
5 . NEW CONSTRUCTION
6 . CURB CU
7 . WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 . ADDITIO
10 . ACCESSORY STRUCTURE
11 . SIG AWNING
12 . PERMIT FE - CHECK ONLY - MONEY ORDER
13 . SPEGZAL 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. S8��b(d f Alterations V
NORTHAMPTON, MASS. "c J 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location r' Lot No.
2. Owner's name Address 1�t3 �A .�'► r i�1 *„� ,
3. Builder's name — Address too
Mass.Construction Supe tsor's License No. MIA Expiration Date
4. Addition /fit 1A
5. Alteration , - ?
6. New Porch At 14
7. Is existing building to be demolished?
8. Repair after the fire N JA
9. Garage N /A No.of cars Size
10. Method of heating N /A
11. Distance to lot lines
12. Type of roof r'
13. Siding house P+1 /A
A
14. Estimated cost-
The undersigned certifies that the above statements are true to the best of his, her
LA j3 D (� o �} knowledge and belief.
m ,-\x iLb
�0 Signature of responsible appican!
Remarks L40 0 11��d G
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002 50 .21
Date Filed File No.
ZONING PERMIT APPLICATION (§10. 2)
1 . Name of Applicant: 4 10 0 ,, ± '
Address: �r Cj Telephone:
2 . Owner of Property: . C .n r" L , S Lesko
Address : I U C-> e 7 rA Telephone: ,j-ff& - 66 r'
3 . Status of Applicant:XOwner Contract Purchaser
Lessee Other (explain : )
4 . Parcel Identification: Zoning Map Sheet# L Parcel# -2/ ,
Zoning District(s) (include overlays) 4t; l
Street Address
Required
5. Existinq Proposed by Zoning
Use of Structure/Property C.r'- `N
(if project is only interior work, skip to #6)
Building height �-
%B1dg. Coverage (Footprint)
Setbacks - front
- side L: —R: 01 L: R:
- rear 15I
Lot size 2 &,-=RCS
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 ad itional sheets
if necessary) JC e �
7 . Attached Plans: _Sketch Plan V Site Plan
8 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
Date: �-;'7. Applicants Signature:
— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —
THIS SECTION FOR OFFICIAL USE ONLY:
ZApproved as presented/based on information presented
Denied as presented--Reason :
special.' Permit and/or Site Plan Required:
i in4Ri d: Variance Required•gnat e ld -Inspector �� at
NOTE: Issuance of a zoning 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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