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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. '�Id Alterations
�
a NORTHAMPTON, MASS.
J 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
r
Garage
1. Location ( v �zY ` Lot No.
2. Owner's name� Address
3. Builder's name -Address
L-Mass.Construction Supervisor'sUcense No. d -txpiration 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-' vv
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible appicant
Remarks
Do an signs Boast on the roe NO V
10. Y 9 property?� YES
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES NO
IF YES, descnbe size, type and location:
11 . ALL INFORKATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF IWFORMATION.
This color to be filled in
by tha Z4ilding, Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minas bldg
&paved parkting)
# .�f `Parking apaces
of Loading Docks
Fill:
volume -& location)
13 . Certification: I hereby certify that the information contained herein
/4i . is true and accurate to the best of my knowledge.
7 -1i '
-16PPLICANT's SIGNATURE
!`TOTE: [ssuanoe of ci zoning permit does not relieve a rkppl;iaanrs burden to oompty with ail
zoning requirementn and obtain all required permits rom the Board of Health. Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
:`.`� FILE #
19
File No. (v
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE1 OR PRINT ALL INFORMATION
1. Name of Applicant: '{7OW S'6 A'-
i
Address: Telephone: S-(f _ ;2 la
2. Owner of Property:
P rtY:
Address: elephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: S'la~ Q/��u+
f
Parcel Id: Zoning Map# Parcel# 4�� District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structuree/P rope rty
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
7. Attached Plans. Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special PermiWadance/Finding ever been issued forlon the site?
NO DON'T KNOW YES ✓ IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained ,date issued:
(FORM CONTINUES ON OTHER SIDE)
FILE
APPLICANT/CONTACT PERSON: r,21C�
ADDRESS/PHONE:
PROPERTY LOCATION: ,rte
MAP PARCEL: ZONE
THIS SECTION FOR.�OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
70NINC,FORM FU,TFD OUT
�' <"
T
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nrd5� -',!A)�2261 4!
ASets of Plans I Pint Plan
TI IOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION-
Approved as presented/based on information presented
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under:§ w/ZONING BOARD OF APPEALS
Received& Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval-Bd of Health Well Water Potability-Bd Health
Permit from Conservati W
--��- =-
Signature of Building for ate 211
`
NOTE:Issuance of a zoning permit does not relieve an nppltoant's burden to oompty with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioabie permit granting authorities.
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