29-143 (3) PERMIT APPLICATIGN CHECK LIST
PAGE PLOT r13 ZONE tC&A' a'(° 3 YES NO �DAfrl
1 . ZONING FORM APPLICATION Pl�l7 Q✓
2 . PERMIT APPLICATION
3 . OWNER OCCUPANT E NT LIC . 0 IF NO
4 . 3 SETS OF S PLAN
5 . NEW CONSTRUCTION
6 . CURB CU "
7 , WATER AVAILABILITY FORMS
8 , REMODELING INTERIOR
9 . ADDITION
10 , ACCESSORY STRUCTURE
11 . SIGN / AWNING ii
12 . PERMIT FEE - CHECK ONLY - MONEY ORDER
� 1
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 , FORM
16 . FILL
COMMENTS : � -
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Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
as"""°roti NORTHAMPTON, MASS. 19 Additions
y APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location /Cl G Lot No.
2. Owner's name U / .. !'? C� Address_
3. Builder's name Address,--'
Mass.Construction Supervisor's License No. (� Cr �� C �l ___Expiration Date
4. Addition
5. Alteration ?C%I t'f �/ c%1 G 4�� `�' h� U _ C>S
d
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 comae , Cc
The undersigned certifies that the above statements are true to e best of his, her
knowledge and belief.
L Signature of responsible app,icant
Remarks
4Date Filed Q '
File No. .1(: i
ZONING PERMIT APPLICATION (§10 . 2)
1 . Name of Applicant.:_
Address : ephone :
2 . Owner of Propert Q
Address : _Telephone : �
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain:
4 . Parcel Identification: Zoning Map Sheet# Parcel# I �,
Zoning District (s) (include rl
Street Address k ip
__ ay {!.
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: R7 ,. 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 Wor /Project : (U e addit ' onal sheets
if necessary)
7 . Attached Plans : Sketch Plan Site Plan
8 . Certification : I hereby certify that the information contained hereii
is tr e and accurate to the best of my knowledge.
Date: �� Applicant' s Signature .
ZApproved THIS SECTION FOR OFFICIAL USE ONL s as presented/based on information presented
Denied as presented--Reason:
S ecial• Permit and/or Site Plan Required:
i ng Re ire : variance Require 4:
i.gnatu
t' u ld7n �a�c tor �p�%A at
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning roquir ents 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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