29-400 VI
PERMIT APPLICATION CHECK LIST
PAGE PLOT 400 ZONE U/?,"\1 W ? P YES NO DATE _
1 ZONING FORM APPLICATION
2 PERMIT APPLICATION
3 . OWNER OCCUPANT STATEMENT LIC . # I NOT
4 . 3 SETS OF PLANS T PLAN
5 NEW CONSTRUCTION
6 . CURB CUT
7 WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 ADDITION
10 . ACCESSORY- STRUCTURE
11 SIGN / AWNING
12 . PERMIT FEE - CHECK ONLY - MONEY ORDER o G
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 . FORM A
16 . FILL
COMMENTS :
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_ Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
aNORTHAMPTON, MASS. 2 t� 19n Additions
APPLICATION FOR PERMIT TO ALTER Repair
rr \ Garage
1. Location C� !� 1 \ Lot No.
2. Owner's name G Address S n
3. Builders name j Address 4�i U
Mass.Construction Supervisor's License No. Q Lr,S I Expiration Date
4. Addition ' 6 t 6 � acl''
U h1
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:-
The undersigned certifies that the above statements are true to the best of his, her
kno d e d b�'�.A
Signature of responsible applicant
Remarks
a 000-.13 .0
Date Filed 10 - a6 - 9� File No. a'?- 400
ZONING PERMIT APPLICATION (510.2) U eA / W S P
1. Name of Applicant S __�
Address: 4 ho Telephone:
2 . Owner of Propert S c
Address: 74 T lephone:
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet#__.1_2_ Parcel# 4,no_1
Zoning District(s) (include overlays)
Street Address 7 Go-n 1 �j H r I ► Ra
Required
5 . Existina Proposed by zonincr
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg.Coverage (Footprint)
Setbacks - front
- side R L 7 D` R D�
- 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) nC'6 MCLc - E' 11v C Lc i
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 knowle
Date:
� � Applicant Is Signature
d
THIS SECTION FOR OFFICIAL USE ONLY:
XT 2 6 IN
Approved as presented/based on information presented
D fed as esented
n f Den ' 1:
igna f Build ' Inspector ate
MOTE: 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 Commisslon, Department of Public Works and other applicable permit granting authorities.
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