35-063 (6) City of Northampton
SSS S"r
`T Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
- 212 Main Street • Municipal Building
Northampton, MA 01060 �St h 1�x
/1 '75
ACCESSORY STRUCTURE PERMIT APPLICATION
(For freestanding structures less than 200 sq. ft., at 1 ast 5 feet from any other structure)
Check#
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: �4 <L IP E 10 4("F S t< 7
Address: q O Q /z-X,4_Pj � Telephone:
2. Owner of Property: S/IV-,
Address: Telephone:
3. Status of Applicant: Owner_Contractor
4. Structure Location-_A_0_ /�-y ��
Parcel ID:Zoning Map# Parcel # District(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Use of Property: Single or Two Family: Multifamily: Commercial:
6. Description of Proposed Structure:
One Story Shed under 200 sq.ft.:--X—Freestanding Deck under 200 sq.ft., less than 30"above grade:
SIZE OF STRUCTURE:
Other(describe):
7. Attached Plans: Sketch Plan Site Plan Plot Plan
S. Does the site contain a brook, body of water or wetlands? NO_X_ 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
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9. ALL INFORMATION MUST BE COMPLETED; PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION.
This column to be filled in by
the Building Department
Existing Proposed Required by Zoning
Lot size
l 1 U4o "+-
Frontage
Frontage N/A N/A N/A
Front: 5 S
Setbacks: Side: S '_
Rear:
S '
Height i
% Open space: qo �
(Lot area minus bldg and
paved parking)
10.Certification: 1 hereby certify that the information contained herein is true and accurate to
the best of my knowledge.
DATE: 3 •-2A)Z-()APPLICANT'S SIGNATURE S ��
NOTE: Issuance of a permit does not relieve an applicant's burden to comply with all zoning requirements
and obtain all required permits from the Conservation Commission, Department of Public Works and other
applicable permit granting authorities