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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. IE3 g �2 Alterations
NORTHAMPTON, MASS. 19 1 Additions
sk APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location �� `` Lot No.
2. Owner's name ��� `I th,�SA— Address 6
3. Builder's name t� h Address S
Mass.Construction Supervisor' License No. GS A`) Expiration Date 11j,(
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- 61V0 e d�
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signs ure responsible appicant
Remarks - �- �� fr�
S
10. 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
IF YES,describe size,type and location:
11 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DOE TO
LACK OF INFORMATION.
.This column to be filled is
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- 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:
(volume & location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: APPLICANT's SIGNATURE .
NOTE: Ins ano of a zoning permit does not relieve an applioant' burden to ly with all
zoning requirements and obtain all required permits from the Board of Health, onservation
Commission, Department of Publio Works and other applionble permit granting authorities.
FILE if
File No. /� G' r
ZONING PERMIT APPLICATION
PLEASE TYPE OR PRINT ALL INFORMATION
Qp
1. Name of Applicant: T`i G� 4W
Address: Lar ` Telephone: 2,53,, 97
2. Owner of Property: ! efr '- d' sy,
Address: ! 44,*yj;-,,1f AQ1 C LaV--1Z, Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Street Address:
Parcel Id: Zoning Map# �_l Parcel# District(s): Sic
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property 12�� 4
6. Description of Proposed Use/Work/Project/Occupabon: (Use additional sheets if necessary):
V
3
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 PermWadance/Finding ever been issued for/on the site?
NO DON'T KNOW 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? NQ- N/ 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
APPLICANT/CONTACT PERSON:
ADDRESS/PHONE:
PROPERTY LOCATION:
MAP PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERNUT APPLICATION CHECKLIST
ENCLOS D REQUIRED DATE
7.nN'fNG FORM FfT,1 ED OUT
F�e Pa id
t
T`�OLLOWING ACTION HAS BEEN TAKEN 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
P mit from F9servation Commission
1gnature of Building Insp for Date
NOTE:lasuanoe of a zoning permit does not relieve an applioant's burden to oompiy with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
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