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PERMIT APPLICATION CHECK LIST
_ / a C- 9 c U RA/ wg
I M c -r c Ci r c/ e, , l--� t o. Yes No Date
1 . Zoning Form Application
2. Permit Application �-
3. Homeowner statement If a licable Lic . Il if of
A. 2 sets of olan v
5.
6. Water De ar ment mPmn
7. Permit fee - check gtLl Y °c v
8 Special Permit renuied with deed if ao
. 9 _ U n d e,� section 1.2 7 C.�._.Z$.(L
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Zoning C-(Azl
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. �8 y S`UO.� Alterations
so NORTHAMPTON, MASS. f Z-7 19� Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location Lot No.
2. Owner's name !�/l/./.�AnI ` t�G/ ✓/�// G/-�SkUC Address �ZOffry P. P4166A ✓ 4----kid S-1- 14_
3. Builder's name .1 Q f - ; /Z /L LS/kl Address
Mass.Construction Supervisor's License No. D/ZVE2 Expiration Date 93
4. Addition /y �f,�/iL�Fx -20 'Lxt " )606F011ac S/Al 1iielkf6 6' '
5. Alteration S/P&3� C-f, c< "'Jo T !3F k'k�G>
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
12. Type of roof P/711 O cesE
13. Siding house S'i aC 6 ltzSt E F'E Uri-fY[�
14. Estimated cost:-
fi
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
216 ri,asx .ILK_
Signature of responsible applicant
Remarks
PAIN, T�SHOP
•t
a �
Date Filed S 2�j�2 , File No. ,,i_G go
ZONING PERMIT APPLICATION (510.2) «R A inrSP
1. Name of Applicant: 70/,iv /F�lirrSK/ Z�'G
Address:X09,e1c 6,o:5 YS> Telephone: 5-9V Vo o 2---
2 . Owner of Property: 74(G,6~4 ya/t�kj Da66i9-�
Address: // Che.,< ,f Sy- yce - —Telephone: 5�8,!: 3
3 . Status of Applicant: Owner Contract Purchaser
Lessee ,t other (explain: 7y l&cr�cD )
4 . Parcel Identification: Zoning Map Sheet# 1-2- _ C_ Parcel#pfd ,
Zoning District(s) (include overlays)
Street Address /j "9W C_ C�.�cL'67-
Required
5. Existina Proposed bv Zonin
Use of Structure/Property ~0-42-7-
(if project is only interior work, skip to #6)
Building height
%B1dg.Coverage (Footprint)
Setbacks - front
- side
- 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) C� vsrt;'l. r k'c, — Dcltt' Ov�e PR���i,JU IW,-W s/D 7
b� .E'f31A�uGF /S�' W r D£ x .�0 7�c�'Jp ~ fI'Boc.T / ` L OW� cPODF T<fi�.✓
7 . Attached Plans: _ c Sketch Plan X Site Plan
8 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
Date: 5'2 2 Applicant's Signatureh Y.
- - - - - - - - - - - - - - - - - - - - - - -THIS SECTION FOR OFFICIAL U
Z- Approved as presented/based on information presented
D,epied as pr ented
e for D h'Aa]:
L.
ignatur uilding Inspector 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.