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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.SW 51- 4& Alterations
NORTHAMPTON, MASS._ .rO2 /t� 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
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Garage
1. Location 114 !3i/r✓�,�1 .� .�.Cuira cc Lot No.
2. Owner's name t c `J IN L L)i rn Address i/ Q '-;Lyj eAUPfy
3. Builder's nameix i hri Address SS% rLy,•v�,�. f
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Mass.Construction Supervisor's License No. -ff S' r2 o,4o l Expiration Date
4. Addition
5. Alteration &-A c-, s r,� .���•,
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_//s/,4 ,�� �C>Z
12. Type of roof
13. Siding house
14. Estimated cost 0 0 00
X
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible app icon!
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10. Do any signs exist on the property? YES L/' NO
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES N(y/
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE To
LACK OF INFORMATION.
This co7u to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L: $0 R: 7 L: ct 0 R: `7 p
- rear
Building height
Bldg Square footageU
%Open Space:
Lot area minus bldg
&paved parking)
# .pf 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: / /y /•9 .APPLICANT'S SIGNATURE
NOTE: lasuanoe of a zoning permit does not relieve an applioant's burden to oomply with,,.atl
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Pubiio Works and other applionbie permit granting authorltles,:._
4.; FILE if
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File No. yo
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: �.��-� hm »
Address: ;�'`3Y GaivhcY _Telephone: -14
2. Owner of Property: "/-D�c,k 22z". -h„ 4011 J A h
Address: //,0 -,�.,,,�,a � Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# Parcel# District(s):
(TOD IN BY THE BU L ING DEPARTMENT)
5. Existing Use of Structure/Property— r
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
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 4--' YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW 4' 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 PERSON: —Q „
ADDRESS/PHONE:
PROPERTY L CATION: i h —
MAP 1 PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
7.0NTNC,FORM FIT.T.F.D OUT
Fee pnod
Fee Paid Cb:�
Additinn to
THE OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION'
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
!Permit from Conserva ' Com on
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Signature of Bui ding or ate
NOTE:Issuance 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 granting authorities.
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