32C-189 1 � r iaBtrl 1 r.r+ ,�_�
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PERMIT APPLICATION CHECK LIST
PAGE 'e3 Z—C—PLOT 166'1 ZONE �Y 1 �k YES NO DATE
1 . ZONING FORM APPLICATION FE:l
2 . PERMIT P IC TIO �—'
3 . OWNER OCCUPANT IF NOT �--
3 SETS OF PLANS PLAN
5 . NEW S
6 . CURB CUT
7 WATER S
8 REMODELING
9 . ADDITION
0 . ACCESSORY STRUCTURE
11 . SIGN AWNING
12 . PERMIT FE — CHECK ONLY — MONEY --ORDER '�
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 — C R 780
15 . FORM A
16 FILL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
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1. Location Lot No.
2. Owner's name Address
3. Builder's name Address
Mass.Construction Supervisor's License No. ,/ s'" Expiration Date
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
12. Type of roof
13. Siding house
14. Estimated cost:- �� a-rJ
\ The undersigned certifies that the above statements are true to the best of his, her
knowledge and beli
Signature of responsible appacbnt
9
Remarks - pe
Rai Date Filed File No.
NING PERMIT A PLICATION (Si0 . 2)
1 . Name of Applicant:
Address: Telephone: 3G
2 . Owner of Property:
Address : Telephone: -
3 . Status of Applicant: Owner -,4/Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# Parcel# M ,
Zoning District(s) (include overlays) &6
Street Address .,u .,
Required
5 • Existing Proposed —by Zoning
Use of Structure/Property '3
(if project is only interior wokk, skit o #6)
Building height
tB1dg. Coverage (Footprint)
Setbacks - front
- side L: R: L: R:
- rear
Lot size
Frontage
Floor Area Ratio
oopen 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) i
'r
7 . Attached Plans: Sketch Plan Site Plan
8 . Certification: I hereby certify that the information contain d herein
is true and accurate to the best of my knowledge.
Date : � f Applicant Is Signature: =
THIS SECTION FOR OFFICIAL USE ONLY:
G��roved as
pp presented/based on information presented
Denied as presented--Reason:
Special' Permit and/or Site Plan Required:
i Require variance Required:
5 §nature Buy. din ector / to
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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