29-408 (7) ramamwAak IIIPW d�� H I f ( Rd - PERMIT APPLICATION CHECK LIST
PAGE 'a,9 PLOT 401 ZONE LLRA ids P YES NO GATE
1 . ZONING FORM APPLICATION v G- D-'9
2 . PERMIT APPLICATION v
3 . OWNER OCCUPANT STATEMENT LIC A IF NOT Y
4 . 3 SETS OF PLANS PLOT P AN 'S
5 . NEW CONSTRUCTION
6 . CURB CUT
7 WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 . ADDITIO
10 ACCESSORY STRUCTURE
11 . SIGN AWNING
12 PERMIT FEE - CHECK ONLY - MONEY ORDER �ly`74 �C5'ao
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 UNDER SECTION 127 - CMR 780
15 . FORM A
16 . FILL
COMMENTS :
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' DEPARTMENT OF BUILDING INSPECTIONS
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INSPECTOR 212 Main Street ' Municipal Building °+M Sv• .
Francis X. Sienkiewicz Northampton, Mass. 01060
HOMEOWNER OCCUPANT STATEMENT
AS A HOMEOWNER OCCUPANT I UNDERSTAND THAT I MAY APPLY
FOR AND RECEIVE A BUILDING PERMIT FOR A HOME OR ADDITION
THAT I INTEND TO LIVE IN.
I ALSO UNDERSTAND THAT I AM RESPONSIBLE FOR KNOWING THE
STATE BUILDING CODE CMR 780 AND ZONING ORDINANCE OF THE
CITY OF NORTHAMPTON.
BEING A HOMEOWNER OCCUPANT AND NOT A PROFESSIONAL
CONTRACTOR IN NO WAY ABSOLVES ME OF ANY RESPONSIBILITY TO
INSURE THAT ALL FACETS OF THE RULES AND REGULATIONS ARE
COMPLIED WITH. I AM AWARE OF MY RESPONSIBILITY TO
COMPENSATE WORKMEN FOR ANY WORK RELATED INJURIES THAT
OCCUR ON THIS WORK SITE IF NOT INSURED.
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SIGN IRE D TE
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 584-4198 Alterations
so NORTHAMPTON, MASS. June 12 , 19 92 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location 89 Sandy Hill Rd . Northampton Lot No.
2. Owners name Albert J . St .Onge Address 89 Sandy Hill Rd .
3. Builder's name Same Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition 8 ' X 12 ' SHED
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 N/A
11. Distance to lot lines 42 ' front , 23 ' side 77 ' rear
12. Type of roof SHED
13. Siding house T 111
14. Estimated cost:- $400 .00
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief. /(
gnature of resp ible applicant
Remarks
PflINT+SNOP
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Date Filed File No. q-� o i
ZONING PERMIT APPLICATION (§10. 2)
1 . Name of Applicant: Albert J . St . On e
Address : 89 Sandy Hill Rd . NorthamptonTelephone: 584-4198
2 . Owner of Property: SAME
Address : Telephone:
3 . . Status of Applicant: Owner XX Contract Purchaser
Lessee Other (explain )
4 . Parcel Identification: Zoning Map Sheet#- Parcel#_y
Zoning District(s) (include verl s) s At
+�
Street Address 47 <� iie-�e(w
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
- rear /ho `
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) Add a 8 ' X 12 Ghpd on side of
7 . Attached Plans : Sketch Plan X Site Plan
8 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
Date : 06/12/92 Applicant' s Signature: r
THIS SECTION FOR OFFICIAL USE ONLY:
P*' Approved as presented/based on information presented
Denied as presented -
a n fo ;D al :
-7-? ;
gna e- f Bui g Inspector Date
NOTE: Issuanoe of a zoning permit doos not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits
from the Board of Hcatth, Consorvabon Commission, Department of Public Works and othor applicabio permit granting authorities.
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