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PERMIT APPLICATION CHECK LIST Page•&Plot
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Address: j ' 1:9a� l �t 1� -j
36 1� '`"-``� `�`� Yes No Date
I. Zoning Form Application
2, Permit Application v 'r
3. Homeowner statement if applicabletLic, #t f no L, l�
4. 2 sets of Iaris-
Curb cut
6. Water Department memo
7. Permit fee chec-k only
P. Special Permit required with deed
9, Under section 127
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Jr -3 Alterations
NORTHAMPTON, MASS. / Pr; 19 QV'�— Additions
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APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location .1 F 2- 6140!2 oh 4 J Lot No.
2. Owner's name re//sc crr 460, ce iZ Address
3. Builder's name Address
Mass.Construction Supervisor's License No. 3 7 Expiration Date 30. 7 .3
4. Addition
5. Alteration (rU tL °✓�d r-
6. New Porch Ire eg i earC �1
7. Is existing building to be demolished? 17 y
8. Repair after the fire
9. Garage YI No.of cars_ Size
10. Method of heating ct 4j 4✓G,-by G r r
11. Distance to lot lines
12. Type of roof QS - 4,
13. Siding house G fvCLtl
14. Estimated cost:- a )
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
3 ure of responsi a applicant
Remarks
Pfl YNOP
1 �
Date Filed File No.
ZONING PERMIT APPLICATION (510. 2)
1. Name of Applicant: <�—
Address: UTelep hone:
2 . Owner of Property:_Ja K56,h-Oltk Lcc`
Address: Telephone: ��a
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain: )
Zoning Sheet# ��� Parcel# / `
g Ma
4 . Parcel Identification: p C
Zoning District(s) (include verlays)
Street Addressg „
Required
5 . Existinct Pro osed by Zoning
Use of Structure/Property
(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)
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 knowledge.
Date: 1 g Applicant Is Signature:
THIS SECTION FOR OFFICIA USE SE ONLY:
1� Approved as presented/based on information presented
Denied as presented
R on for nial: �-
S ', at e o Buildiacf(Inspector Date "
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.
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