17A-113 PERMIT APPLICATION CHECK LIST
PAGE /7)9 PLOT /(3 ZONE aiR02` E? C&/-41.' ° YES NO DATE
1 , ZONING FORM APPLICATION
2 , PERMIT APPLICATION
3 . OWNER OCCUPANT STATEMENT ('1'LI9# IF NOT
3 3 • 0
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 DER 205,;
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 CMR 780
15 , FORM A
16 . FILL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs.Alterations.etc. Tel.No.
`�'-r Alterations
'v
NORTHAMPTON, MASS. L4 `� 1 g�`� Additions
;',!..i:47.`
APPLICATION FOR PERMIT TO ALTER Repair
,� Garage
( to c. <✓i.0 Li Lot No.
1. Location � \- Cl I i f'� E
2. Owner's name G(G(Ct'f'_, -----Ook.A.)- t 3 Address LA c∎ck,r , : *--\ , .-,e c_
3. Builder's name VIA L\C ) L F- t Address <S \ k ~-,A.�.‘kv \,p to 4''\'
Mass.Construction Supervisor's License No. b4)-3`-A 3 Li Expiration Date 0_ — `1-1
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 f
12. Type of roof �-e v�00-'� e X-eQOc';r.; _ `7�.�,c1� `� �.--� �o: �' I q& rc,ct,-+C_
13. Siding house
14. Estimated cost:- > `a;'CC)
The undersigned ce ies at the ve statcm is are true to the best of his. her
knowledge an bd. f. /
Signature of responsible app,icant
Remarks
h
cl/ /. i n
Date Filed File No.
ZONING PERMIT APPLICATION (52.0. 2)
1 . Name of Applicant: 11A k 1 mkt'\v‘ .
Address: �-t, \ (-„ ,..{ �\,, \v.? Telephone: t9i
. 2 . Owner of Property: . (, ,r e.,._ �1- : �,"S
• Address: • .y ( \ ,I- -( Telephone: .
3 . Status of Applicant: Owner Xcontract Purchaser
Lessee Other (explain ) .
4 . Parcel Identification: Zoning Map Sheet! /2/9 //, Parcel! //3 ,
/
Zoning District(s) (include verlay ) a./7, tips.
Street Address 9' t!=� . , e / , -
Required
5 . , : Existing 2 Proposed by Zoning
Use of Structure/Property 7 t',, - ,?
(if project is only interior worx, skip to #6) 7
Building height
%Bldg. 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) 7
•
6 . Narrative Descrytion of Proposed Work/Project: (Use additional sheets
• if necessary) -t�,vw,,},- -k -e arc-e;- 43 V\\../..i t_\','S s. `a\--∎-<--\
'r
7. Attached Plans: Sketch Plan Site Plan
• 8 . Certification: I hereby certify that the information co tai d he ein
is true and accurate to the best of my knowledge.
Date: (p--c- CI c-• Applicant's Signature: C
I/ THIS SECTION FOR OFFICIAL USE ONLY:
Approved as presented/based on information presented
pp . .
Denied as presented--Reason:
Special' Permit and/or Site Plan Required:
• ' d'ng Re• • lred: Variance Required: .LP
S. gnatu e :f ilding I - - • - to
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with ail zoning requirements and obtain all required permits
from the Board of Health,Conservation Commission,Dopartmont of Public Works and other applicable permit granting authorities.
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