29-387 (6) PERMIT APPLICATION CHECK LIST .
•
PAGE r� PLOT `� 7 ZONE (-i p/\ S NO DATE
�ranlS� c�
ac���' d r
ZONI FO APPLICATION � - I 3
2 , PERMIT APPLICATION
3 . OWNER OCCUPANT NO
4 . 3 SETS OF S PLAN
5 , NEW CONSTRUCTION
6 . CURB OUT
7 WAIER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 . ADDITION
0 , ACCESSORY STRUCTURE
11 , SIGN / AWNING
2 , PERMIT FEE - CHECK ONLY - MONEY ORDER
�n
3 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDIER SECTION 127 - CMR 780
15 . FORM A
16 . FILL r
COMMENTS :
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44
j DEPA R7'10 ENT ()I,' INSPECTIONS
212 AL,1nH,%, Sh,(�01 Aifiwicipal Biiildin(V
INSPECTOR Northainptoji, 1�4ass- 01060
S( 1jr) rUEL BURNING A1'PLIANC1,, & C111"NEY APPLICATION PERMIT NUMBER
Pnge Zone
Location 16 ki
Owner or
(Malliass; Aod •ess) (Tole. No. )
a r-,.1") (Address) (Tele. No. )
(ESIDENTIAL NON-RESIDENTIAL
farrii1v Home Business
Mo,-P Other
i b e r of 11ni.t.- Fsp cc i.f y
►ries it Bitilding
X, Wood burning
d Coal.
)e1ed Combination
page of Purchase Other
Specify
7 1) L!
Type
-
Manufacturer k/o -ro
i.,
Purchased From
(Name of Firm)
(Address)
Cost Construction & ApjAiance $
Chimney New Metal Bestos
)4 Existing Interior chimney
Separate Flue Exterior chimney
Other appli• nce attached to fille
Masonary Limed
Unlinrd
Notes & Data:
Gil )n /3 V
Signature of Applicant: Z/
(Address)
Approved By:
Title: Date-
a V
y
v
00075%)
Date Filed 3- - 93 File No. Q9 - 39"7
ZONING PERMIT APPLICATION (510. 2) Ct R
1. Name of Applicant: A/W&&r�I /1 vu� /to y
Address: et3 6'1%-,A' Telephone: 3' J'&
2 . Owner of Property:
Address: Telephone:
3 . Status of Applicant: �\ Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# .4*L-! Parcel# 3� r
Zoning District (s) (include erla ) ►ti
Street Address
Required
5 . Existing Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #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) 4,&c `d Aa,�4,r''co F-6,1 J1Z 4-/fir T�
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: � � �/ 3 Applicant' s Signature:
^THIS SECTION FOR OFFICIAL USE ONLY: — °-� ,
Approved as presented/based on information presented p. MAR 2
Denied as presented--Reason:
Special Permit and/or Site Plan Required: ,;y �ixkF.
Vlin�d ' ng R uired: Variance Required: ;,
ignat e f Build' Inspector � 0 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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