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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
Frontage N/A N/A N/A
Front:
Setbacks:
Side: L: R: L: R:
Rear:
Height
% Open Space:
(Lot area minus bldg and
Paved parking)
10. Certification: I hereby certify that the information contained herein is true and accurate to the best
of my knowledge. tiit
DATE: 7'' t(' Au 13 APPLICANT'S SIGNATURE
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.
;HAM City of Northampton
4- T Sty' SAC
Massachusetts
( ECEIVFD
s 1PARTMENT OF BUILDING INSPECTIONS 2"
Main Street • Municipal Building
4� " 1 7 Northampton, MA 01060 ' Y V.'
INSPECT••
tPA CtiF l a
ACCESSORY STRUCTURE PERMIT APPLICATION
(For freestanding structures less than 200 sq. ft., at least 5 feet from any other structure)
Permit Fee: $25.00 Check# 56'
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: '-n ' �� y [ V U L I N D f L . L)12 , tic,
Address: S7 0/ZS 13 Or Telephone: c , '� 75
2. Owner of Property: R.t v Y2-0 C• A Np L.J PVA L 0 ( Its
Address: a' I i N c.., 5'i L r c Telephone: 5 p ' 775
3. Status of Applicant: k Owner Contractor
iO53
4. Structure Location: RIA R. of y 1D b
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.: V Freestanding Deck under 200 sq.ft., less than 30"above grade:
Other(describe): O )(- cS
7. Attached Plans: Sketch Plan I Site Plan Plot Plan
8. Does the site contain a brook, body of water or wetlands? NO I/ 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
kg\‘3
CONTINUED ON NEXT PAGE I
4 _IL-9
CIO
81 FLORENCE ST BP-2013-0955
GIS#_ 763 COMMONWEALTH OF MASSACHUSETTS
Map: 1
Block: 0669 9 CITY OF NORTHAMPTON
A 1.4p):9
Lot: 001
•_ 1�
47
Category: shed
,Permrt# BP-2013-0955 ` �����,y0., BUILDING PERMIT
Project# JS-2013-001603
Est.Cost: $200.00 E "%
Fee Charged: $25.00
Balance Due: $.00 _ PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License: Expires:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): 19994.04 Owner: BURQUE RICHARD C&LINDA L
Zoning: URA(100)/
~A pp i Applicant: BURQUE RICHARD C&LINDA L
Units Gained:
lUnits Lost: AT: 81 FLORENCE ST
;Dig Safe#:
ISSUED ON: 18-Apr-2013 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
ERECT 8 X 12 SHED
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Electric Gas Plumbing Building
Underground: Underground: Underground: Excavation:
Service: Meter: Footings:
Rough: Rough: Rough: Foundation:
Final: Final: Final: Rough Frame:
Fireplace/Chimney:
D.P.W. Fire Health
Insulation:
Meter: Oil:
Final:
House# Smoke:
Treasury:
Water: Alarm: Assessor
Sewer: Sprinklers: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF
ITS RULES AND REGULATIONS.
Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
shed REC-2013-005686 18-Apr-13 7465 $25.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov
GeoTMS®2013 Des Lauriers Municipal Solutions,Inc.