29-304 (4) PERMIT APPLICATION CHECK LIST
PAGE -�7' PLOT ICLI ZONE LIRA '40G A --rc F)-r oo t�- YES NO DATE
ZONING--FORM ZONING--FORM APPLICATION-- FLn--r rlc�f_ �-- 4-�zo- 93
2 .-- E I-C �--
3 , OWNER OCCUP A-N-T--STATEMENT LIC # I F NOT-'9:0 1� t—
4 . 3 SETS 0 NS PLAN
5 NEW CONSTRUCTION
6 . CURB CUT
7 . WATER V BI FORMS
8. REMODELING--INTERIO
9 . ADDITION
0 . ACCESSORY STRUCTURE
11 . SIG AWNING
2 . PERMIT FEE - CHECK ONLY - MONEY ORDER r 20.
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. Alterations
ti
NORTHAMPTON, MASS. 19 Additions
`•
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location �neeZOZeW [J!Z - /O�t C�� �� Lot No.
2. Owner's names:-Mley Q 1 L°a/r - Address-4/06 E
3. Builder's name �4t l 6Rsr e Addres � Ran ponp
G +C-e--
Mass.Construction Supervisor's License No. Expiration Date 6-3o ' 1'3
4. Addition
5. Alteration !I
6. New Porch Q �� �'�;Q � �oC C'ci�•., DEC �l�t w�
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
13. Siding house
14. Estimated cost:- 12 C�-Cl, 0-0
The undersigned certifies that the above statements are tru to the best of his, her
knowledge and 'ef.
Sig azure of responsible app,icant
Remarks
•
0
(1
;101 000 V Date Filed cc- /� - �3 File No. a9' -3o1f-
ZONING PERMIT APPLICATION/ (§10 . 2) u A
1. Name of Appl ' ca
Address: /�,y1.1� Telephone:
2 . Owner of Property:
Address : d106
A Telephone :
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# / P rcel#
Zoning District (s) (include overlays) CJ/T
Street Address r- c7 ,
Required
5. Existi Proposed by Zonin
Use of Structure/Property
(if project is only interior work, skip t d #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) '142 J
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 knowled e.
Date: 41_121e-�3 Applicant' s Signature:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
THIS SECTION FOR OFFICIAL USE ONLY:
ZApproved as resented based on information resented
p / p
Denied as presented--Reason:
S ecial Permit and/or Site Plan Required:
4ng R it Variance Required:
iignati�Ar&`of Buildin ector Dat 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 althorities.
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