18C-094 PERMIT APPLICATION CHECK LIST
PAGE ifi PLOT q' ZONE CC. '6 � 4 -'21 01 )(-: YES NO DATE
otoiL, 1017-q“
1 ZONING , FORM, APPLIQATTQN
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2 . ` t#1 1` " APL` CATION-
3, OWNER OCCUPANT STATEMENT !. If NOT
4, 3 SETS OF PLANS /PLOT PLAN
5. NEW CONSTRUCTION
6. CURB CUT
7. WATER AVAILABILITY FORMS
8. REMODELING INTERIOR
9. ADDITION
10. ACCESSORY STRUCTURE
11. SIGN / AWNING
12. PERMIT FEE — (ONLY — MONEY ORDE144 6 5'
13. SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14, UNDER SECTION 127 — CMR 780
15. FORM A
15. FILL
COMMENTS:
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Zoning
Miscellaneous Additions, Repairs, Alterations, etc. Tel. No. Alterations
a NORTHAMPTON, MASS. C CA 0 \T>CA v 19 9 'Is Additions
,t Repair
» skel , ' . APPLICATION FOR PERMIT TO ALTER g Gera e
- �pp
1. Location O O 4 t4k-( 011 r (3� ' Lot No.
2. Owner's name ^itA j ,At4 L 0't V Z Address S(Vt't1~
3. Builder's name c' i✓1 C 00 e.,, ,7 .h :K71 et, Address . L i WC.... V S1 2.AsVievt* Mkt .
Mass. Construction Supervisor's License No. O t (") ( Expiration Date C '1 ' e l — e l s
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 /l
12. Type of roof tht�, � l V I�%t CAA C 4'00t Al
13. Siding house o
14. Estimated cost: 1 i 11 ®._Q•
U` The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief. i
�u ! �� Signature of responsible app,irant
Remarks
U
Ni�yti 4
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Date Filed
�d1U 0 co �J Fil No. ��1�:.,t
ZONING PERMIT APPLICATION ( §10.2)
1. Name of Applicant: P`\ P+OoQt+%i '
Address: k( • � • , 014. tlephone:
2. Owner of Property:
Address: 9 0 l e hsv-1 r Telephone:
3. Status of Applicant: Owner Contr,ct Purchase
Lessee Other (explain: ecDOV Cc^ d 4c.
.;� )
4. Parcel Identification: Zoning Map Sheet# iParcel# C14 ,
Zoning District(s) (include overl s ) l
Street Address )' 4A-e .
Required
5. Existing Proposed by Zoning
Use of Structure /Property Rehm
(if project is only interior work, 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 Description of Proposed Work /Project: (Use additional sheets
if necessary) {boo c sA- -4r Ara. VO46A � ; � ( eAN.
. 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: I-4-d
QG� a� �"I,1� Applicant's Signatur •
THIS SECTION FOR OFFICIAL USE ONLY:
Approved as presented /based on information presented
Denied as presented -- Reason:
pecial'Permit and /or Site Plan Required:
F ing R, iced: Variance Required:
�i
1� i 3 �3
gnat- of Build' -. Ins ec or. Da e
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.
°�" �• City of Northampton REQUIRED INSPECTIONS
g '! 1. Footings and Walls
r �r n.- . g
� •
BUILDING D 2. Structural Components in Place*
•
Wgi*W 3. Complete Building*
No.
1040 Office of the Building Inspector
Zoning Form No. 001921 Date 11/10/93 Fee $ 20 Check -- # 1491
Page, 18C Parcel 94 URB Section 127 ❑ Yes LI No , Zone
BUILDING PERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Pepin Roofing & Siding before Building Inspections
has permission to Re- shingle garage and porch roofs Inspection on Site — Foundations
situated on 20 Gleason Road Inspection of Plumbing —Rough
provided that the person accepting this permit shall in every respect Inspection of Plumbing— Finish
conform to the terms of the application on file in this office, and to the Gas Inspection
provisions of the Statutes and the Ordinances relating to the Construction, Inspection of Wiring —Rough
Maintenance and Inspection of Buildings in the City of Northampton.
Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring — Finish
of this permit. Expires six months from date of issuance, if not started. Building Inspection Rough
Note: A certificate of occupancy will be issued by this office upon return Insulation Inspection
of this card signed by the Plumbing, Wiring and Building Inspectors.
Building Inspection— Finish
Smoke Detectors (Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUO S • L ON THE PREMISES
Certificate of Occupancy
.�s • g Inspector
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