32C-287 (3) > 2
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No."?!?�' y5 y Alterations
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1 NORTHAMPTON, MASS. R-1 2 191_i2, Additions
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APPLICa ATION FOR PERMIT TO ALTER Repair j& k Garage
1. Location Lot No.
2. Owner's name Address
3. Builder's name Address
Mass.Construction Supervisor's License No. 0 �4a !2'7 Expiration Date 0;Z0 90 �2
4. Addition
5. Alteration
6. New Porch
7. Is existing building to be demolis ed.
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8. Repair Ad=a.,.&
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
knowledg and belief.
Sig ure sponsible app ican!
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 col— 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 contained herein
is true and accurate to the best of my knowledge.
DATE: APPLICANT's SIGNATU
-i Wo.
NOTE: Issuanoe of at zoning permit does not relieve applioa ur e t ply with all
zoning requirements and obtain all required permits from the and o Ith. Conservation
Commission. Department of Publio Works and other applionble permit granting authorities.
FILE if
-a p
IIS C
File No. rye _
DE, or
ZONING PERMIT APPLICATION (§10 . r�
PLEASE TYPE OR PRINT ALL INFORMATION w...,.,
1. Name of Applicant:
Address: Telephone: L{/ ,3
2. Owner of Property:
Address: Telephone: 6 9'�e
3. Status of Applicant: Owner Contract Purchaser Lessee
_Other(explain):
4. Street AddrA�:) �7
Parcel Id: Zoning Map# Parcel# C/ _ District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property ��e"�' �&�� -
6. Des 'peon of ro d se/W Project/Occupati n: (U e ad.dl al sheets if ne sary):
? .o, . : rI"r ...
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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 Permit/Variance/Finding ever been issued for/on the site?
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)
.! r
FILE # n
APPLICANT/CONTACT PERSON•t; t
ADDRESS/PHONE: -- G - ----
PROPERTY LOCATION: ' t
MAP 5 o� _. PARCEL: ZONE 4C
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Fe�Paid
3qPtq0f`P1nny /`Plnt Inn
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OLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
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
Pe it fro nse tion Commission / /.I-
11
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Si ature of B i g Inspector ate
NOTE:Issuance of a zoning permit does not relieve an plioant's burden to comply with all
zoning requirements and obtain all required permits rom the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
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