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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. d j q j�j� Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location Lot No.
2. Owner's name Address 1.1i j
3. Builder's name d Address
Mass.Construction Supervisor's License No. 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-
The undersigned certifies th above stateme are true to the best of his, her
knowledge and be
-' Sig ure 0 responsible app,icani
Remarks
10. Do any signs exist on the property? YES NO
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, describe size,type and location:
11 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This cols to be filled in
by the Building 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 minus bldg
&paved parking)
# of Parking Spaces
# of Loading Docks
Fill:
(volume & location)
13 . Certification: I hereby certify that the information V d herein
is true and accurate to the best of my knowle
DATE: APPLICANT's SIGNATURE
NOTE: Issua of a zoning permit does not relieve an a lioant's burden to oomph with ail
zoning requ r'ements and obtain all required permits from the Board of Health, Conservation
Cory sion Department of Publio Works and other applionble permit granting authorities.
FILE if
r � t
File No.,(( D` :) . uv `?
ZONING PERMIT APPLICATION (§10 .
PLEASE TYPE OR PRTXT ALL INFORMATION
R
1. Name of Applicant: `
Address: ` phone:_T ��
2. Owner of Property:
Address: — Telephone:
3. Status of Applicant: Owner _Contract Purchaser Lessee
Other(explain): jJ�
4. Street Address:
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE 8UILDING DEPARTMENT) 7
5. Existing Use of Structure/Property
6. Description of Propose Use/Work/P e Occupation: (Use additional sheets if necessary):
s
- r
7. Attached P 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 Permit/Vadance/Finding ever been issued for/on the site?
I
NO DON'T KNOW YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T 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 PERS N: r-
ADDRESS/PHONE:
- 77
PROPERTY L CATION:
MAP PARCEL:_ ZONE
THIS SECTION FOR_OFFICIAL USE ONLY:
PERNUT APPLICATION CHECKLIST
ENCLOS D REQUIRED DATE
7,nN1rNC-FORM FILLED nTTT
Ei-P Paid
A"?
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THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATIOM <'
_IZApproved 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
!P rmit from nserva ion Commission /
�� SS
Si ature of pector - — ate
NOTE:Issuanoe of as 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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