35-029 (14) DEPARTMENT OF PUBUC SAFETY
COMMONWEALTH 1010 COMMONWEALTH AVE. A
"1 OF BOSTON, MASS.02215 '
MASSACHUSETTS ENCLOSE CHECK OR MONEY ORDER
FOR REQUIRED FEE,
EXPIRATION DATE !,"J • I, '')i�
r f b MADE PAYABLE TO
q: I 7 n I.i 99 a EFFECTIVE DATE LIC-NO. °
RESTRICTIONS "COMMISSIONER OF PUBLIC SAFETY"
,',(DO NOT SEND CASH).
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PHOTO(BLASTING OPR ONLY) FEE:
: FFICTIyE FETO
NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY
HEIGHT:
STAMPED-OR-SIGNATURE OF THE COMMISSIONER
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2/ 2 1 '>rtl `L�1 //� J v ( I.eT .ACH LICENSE t, TU3
'-�,q. SIGN NAME IN FULL-ABOVE SIGNATURE LINE
THIS DOCUMENT MUST BE SIGNATURE OF LICENSEE
' CARRIED ON THE PERSON OF
THE HOLDER WHEN ENGAG COMMISSIONER
.OTHERS -RIGHT THUMB PRINT ED IN THIS OCCgPATION
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
a NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location 9 �CIW pp Lot No.
2. Owner s name_gk-b 4 �- , W i I S l- Address S' �,P r 7-4 J
3. Builder's name n w.►a a�j- F 0 61--J Address
Mass.Construction Supervisor's License No. 0 l 1 0267 Expiration Date � 3 73
4. Addition
5. Alteration
6. New Porch
7. Is existing building to be demolished? A9A
8. Repair after the fire IZ-P- P('k e e a -e q
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:- bts
r
The undersigned certifies that the above statements are true to the best of his, her
knowl dge and belief.
Signature of responsible applicant
Remarks
P P
Date Piled v File. No 3 6,- o cy'
._. ZONING PBRMIT APPLICATION (§10 . 2 ) U RA
1 , Name .of A plicantl w� L �,r►'����"'
Address t Telephone e
2 , • Owner of Property t b �-,i JAJct
Address : t Telephone l
3 , • ,Status of Applicant ; Owner Contract Purchaser
Lessee Other (explarF. 0,aNI LNa c �sL
4 . Parcel Identification ; Zoning Map Sheet#__,�(�__
Zoning District (s) (in;clude verlay )
Str•eet Address ��
• lZuquirod ,
5 , Ilxtatzn� Proposed 1?x_: .QUA t
Use of Structure/Property .H�ti`
(if. project 'is only intorior work, skip to //6 )
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BuiiIg height ' _-----
.. kPlclC� . coverage (Footprint) — —
S,etbacks - front -
sidd
rear ----Lot-'size - -•-
Frpntage
F.l•oor, Area Ratio
kapean Space (Lot Area 'Minus
and parking) _...:..__.
Pal Xingj Space.s
Signs -._.._
16`ill (volunle & location)
6 , Narrative Description- of Proposed Work/Projpctl (Use additional .Flheets
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7 . Attached Plans : Sketch Plan site P1'an
8 certification : .I ' hereby certify .that the information contained he.rain
is true alld accurate to the best of my knowledge .
Date l 3 Applicant 1•s Signature l _ �
., •.• ..• _ ^ -'THIS SECTION Von Of,-,i0fAL U8D OHL I - .. 7
:.Approved as 'presented/based on inforhiat'ion' presented
�Dellied as presents,d .
eason• r Dehlal l
cyna of Bu lc g Inspector
NOTE: Inuanou of a zoninp,pormlt dooa not rolluvo an appilount'a burdon to comply wlUi all zoning roquiromonto and obull all 1, quip-i porlrm
from Iho Board.of l•lonith, Conaorvadon Cornmlaalon, Dopartmont of Publlo.Worka and oUior applicablo ponnit praiLinp authoiltloa,.•.
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