37-060 (10) r� PERMIT APPLICATION CHECK LIST
PAGE / PLOT 6'0 ZONE �fL�A- ��7 .VAU-Gt- ES NO DATE
1 . ZONING FORM APPLICATION
2 . PERMIT I
3 . OWNER OCCUPANT STATEMENT LTC IF NOT
4 . 3 SETS OF PLA t4
5 . NEW CONSTRUCTION
6 . CURB CUT
7 , WATER
8 . REMODELING
9 . ADDITION
0 , ACCESSORY STRUCTURE
11 , SIGN / AWNING
2 , PERMIT FEE - C - MONEY ORDER o V
13 , SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABL
14 , UNDER SECTION 127 - CMR 780
15 . FORM A
16 , FILL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. �� /r 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location �-- G�t` &T Lot No.
2. Owner's name ILK 0 r 6r- Address U rK J r1
3. Builder's name 60 t C I P A P k L-' �°C Address �� -&I
Mass.Construction Supervisor's License No. n C? /J. Expiration Date 6
4. Addition
5. Alteration
6. New Porch
7. Is existing building to be demolished?
8. Repair after the f`irree, A L L L /4j 1=0
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- ���{�� c; ✓�
The undersigned certifies that the above statements are we to the best of his, her
knowledge and
Signature of responsible ant
Remarks
Date Filed File No.
ZONING PERMIT APPLICATION
I. Name of Applicant: Wte- j=
Address :1��� � .W Telephone: g=K, 7/6,7
2 . Owner of Property:
Address: i u c n i Aa,j, Telephone:. S,7� c
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain )
4 . Parcel Identification: Zoning Map Sheet#_ Parcel# . r
Zoning District(s) (include over ays) �-
street Address i`l"�
Required
5 . Existincr , Proposed by Zoning
Use of Structure/Property
(if project is only, interior wbrkj skip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
- side L: R: L: R:
- rear
Lot size
Frontage_
Floor Area Ratio
. %Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume location)
6. Narrative Descri Lion of Proposed Work/Projec Use additio al she
if necessary) I�'.r
Y
7. 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: � 3 Applicant's Signature:
/ THIS SECTION FOR OFFICIAL USE ONLY:
—6 Approved as presented/based on information presented
Denied as presented--Reason:
S d al' P it and/or Site Plan Required:
Ong ed: variance. Required:
. gnat uilding Inspector �'Y a
NOTE: issuance of a zoning permit does not reitove an applicant's burden to comply%ft all zoning requirements and obtain all required pormfts
from the Board of Hoalth.Conservation Commission,Department of Public Works and other applicable permit granting authorities.
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