29-351 (9) PERMIT APPLICATION CHECK LIST
:�.9 ::35 URFl � 'SP
tl•p A u 5 i-,-n Or-r-c l e Yes No Date
1 . Zoning Form Application
2, Permit Application
3. Homeowner statement if a licable Lic. # if not
4. 2 sets of plans
5. Curb —•---
6 Water D mQmn
7. Permit fee - ch ck o
8. Special Permit required with deed if aDplicable
9. Under section 127 _-
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' DEPARTMENT OF BUILDING INSPECTIONS
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INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
AS A HOMEOWNER I UNDERSTAND THAT I MAY APPLY FOR AND RECEIVE
A BUILDING PERMIT FOR A HOME OR ADDITION I INTEND TO LIVE IN.
I ALSO UNDERSTAND THAT I AM RESPONSIBLE FOR KNOWING THE STATE
BUILDING CODE AND ZONING ORDINANCE OF THE CITY OF NORTHAMPTON.
BEING A HOMEOWNER AND NOT A PROFESSIONAL CONTRACTOR IN NO WAY •
ABSOLVES ME OF ANY RESPONSIBILITY TO INSURE THAT ALL FACETS
OF THE RULES AND REGULATIONS ARE COMPLIED WITH.
Signatu Da e
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. l� ' I `1 Alterations
r NORTHAMPTON MASS. 1 g Additions
(HAMp
20 p ti
e e Repair
APPLICATION FOR PERMIT TO ALTER /
" Garage �\
1. Location
40 Lot No. �
/t - t
2. Owner's name l �� S Address (4c- � GK
3. Builder's name s k" E- Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
6. New Porch
7. Is existing building to be demolished?
8. Repair after the fire
9. Garage .:Z X ao� . No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof, tL� !�t mot`
13. Siding house
14. Estimated cost:-1
The undersigned certifies that the above statements are true to the best of his, her
knowled d belief.
ignature of responsibl cant
Remarks
PHINTnSHOP
Date P'i'led
._ Pile , No
ZONING PEW4IT APPI,TCA11110H (,rj 10 , 2 )
I Name ;of Applicant : _
Address r •.qc� 2�elgphono l -___
21 ' Owner: of Property ; j s
Address ) Telap one )
3 , Status 'oZ Applicantc„ZOwner Contract Pgrohase,x
Lessee Other (expla ;_ _� y
A , Parcel Ide►itification ; Zoning Map Sha Pacool,l:51 5
2onincf Distr iot (s) . ( inblu e_-o_Y..4rlays)
Street Address
51 Ic.j.si i► rropoaad 11ucr�,il od ,
)o YY.,: o i t1g
Use of. Structure/Pronert•y _
(if. project 'is only int ovior work, sk h to 116 )
Bui-14i),iy height
E}ldc� , Coverage (Footprint) _
S,ot};►acks -
front
- sidd 62 _
- rear 5�c/-LL
Lot s ze �'-
Yrantaye w
P',loor, Area Ratio
40 w11 Space (Lot
.i''Xd.irig and park.iny)
Pa.Xiiiq� -space,a _..,.._w
Signs
. lii I'll (vo2 ume h 1 oca ti ot1) _.
6 Na1.^xY t.tve Description- of PrOposed Work/Pr.oJ,ec ••I (Use additional , �l��ets
' �j: 1'!(`vCiO99ar ) � 1C�-� i CS In •� � c .
1
7'. Attached Plans l Sketch Plan site pl'a;n
8 ,' . ; Qaxtizicationl Thereby certify , that the information oont'uinecl tIc- ein
1*4 true and accurate to the bosh of my knowlo a ,
-c Applicant ►•s signature
—• .,, ~. — �.
MIS SECTION Pon OBIVICIAL. UFJN OnY1 " 1
�'Approve-d as 'pr esentedlhased o» i1� oxmat'ion' prosontQd
Denied as presented .
As0 x1;L'or.DeiiialI
'S. cjnatu : Bu IC1.1 -1n,5pG,ct0r ;17atQ
NOTi; Inuanou of a zonlnp,pam►fl dove not rollwo an appllconCa btlydun to cornpt wlUi all zonlnp roqulromonw and ohiafn a!l
(loin k Board.of Honk)►, Concomi.lon Commlaalon, NpNln►ont of Publlo Worko and oUior opplloablo pon Il u
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