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"I P
30 /CLlj y PERMIT APPLICATION Cht... =�
PACE 92 C PLOT Off- ZONE 0 RC' YES NO DATE
1 . ZONING FORM APPLICATION
y- G
2 . PERMIT APPLICATION
3 . OWNER OCCUPANT STATEMENT LIC # IF NOT f''!
4 . 3 SETS OF PLANS PLOT PLAN e-Cc k,
5 . NEW CONSTRUCTION
6 . CURB CUT
7 WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 . SIGN ING
2 IT FEE - CHEC ONLY - MONEY ORDER
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 . FOR
16 . FILL
COMMENTS:
i3Ar+ C�rd o r\ 600 r-l.t i is
30 '11a iej St.
js►or aw ptov%,M401060
t ( "� app ro x via +C4 Y
p Ad r
r
W
dY
�� ff
h�
2 Sfor 4
wood Pram
1iourge U
pa rya a.%
36 1
140
44
� � Massachusetts
' DEPARTMENT OF BUILDIXG INSPECTIONS
a
INSPECTOR 212 Main Street ' Municipal Building 'o
,y Spa`
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.
SIGNA' &E DATE
>
0 0 rA
C,
z 0
Z
0
>
rD
o- Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 4,.e Alterations
NORTHAMPTON, MASS. 19 6 Additions
ti
APPLICATION FOR PERMIT TO ALTER Repair
Garage
—
I. Location 3 D /'4k L ie- t Lot No.
2. Owners name % w yAddress--o t*
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition 'A.
5. Alteration -1L 41&t 01 t A t
6. New Porch
7. Is existing building to be demolished? C
8. Repair after the fire
9. Garage
No.of cars Size— f-
-J 2 -AL
10. Method of heating
11. Distance to lot lines t - t-.ILL
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
knowledge and belief.
Signature of responsible applicant
Remarks
PRINT•SWOP
PR P
i
Date Filed
File No. Sa C- acy-5-
ZONING PERMIT APPLICATION (§10 . 2) L( R G
1 . Name of Applicant: 13ar t-
Address : b o .r ate+, _��. ,.r ,v-t �. � � , Telephone: �-I �[�►�®� ' -t �
IV I R 11-
2 . Owner of Property: �4 It o_
Address : Telephone:
3 . Status of Applicant: --, Owner Contract Purchaser
Lessee Other (explain )
4 . Parcel Identification: Zoning Map Sheet#-3'Zc— Parcel# 7-` s r
Zoning District (s) (include overlays) aJ: G-
Street Address 3oVQtl� St
Required
5 . Existina Proposed bv zoning
Use of Structure/Property LA& q -46 f .�
(if project is only interior work, skip to #6)
Building height '► a
%B1dg. Coverage (Footprint)
Setbacks - front
- side
- rear
Lot size
Frontage •. ^ A.
Floor Area Ratio
%Open Space (Lot area minus
building and parking)
Parking spaces ----1 4.
Loading -.
Signs
Fill (volume & location)
6 . Narrative Description of Proposed Work/Project: (Use additional sheets
if necessary) v%+ A., 4 en
iV
r
7 . Attached Plans : e Sketch Plan Site Plan
8 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
Date: 10 a Applicant ' s Signature:
THIS SECTION FOR OFFICIAL USE ONLY:
G.
Approved as presented/based on information presented
Denied as presented
Reason for Denial :
Signature of Building Inspector Date
NOTE: Issuanoe 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 Commission, Department of Public Works and other applicable permit grunting authortties.