29-269 (2) � IJ.Afp?Q
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l� DPPAATk(8N7' O!+ 13UILDPT0 INSPE(7NONS
INSP6C1'OR 212 Main Strect ' A�lunicihal Building
Northampton, Mass, 01060
AS A HOMEOWNER I UNDERSTAND THAT i MAY APPLY FOR AND RECEIVE
A BUILDING PERMIT FOR A HOME OR ADDITION I INTEND TO LIVE IN
I ALSO UNDERSTAND THAT I AM RESPONSIBLE FOR KNOWING THE STATE
BUILDING CODE AND ZONING ORDINANCE OF THE CITY OF NORTHAMPTON ,
BEING A.HOb1C WNER 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 ,
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
a NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location d13 ZQd/�j U le tv ,D4{✓je Lot No.
2. Owner's name r1 0 4 N N - A-4 9 p 6 l e",,G Address OrX t A y d f! k j Z24 ,
3. Builder's name S+0 n10 Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration Ce L liv H A I CA w g ,�
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:-` 1 O a 0
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
i lure of responsible pplicani
Remarks
PR
Date riled File No ,
7021' NG z FJt?d J:`1' 7�PL�T�ZCh`I'TON
Zoning o.rdilltlI' •e ;3acti.on 10 . 2
1 , Name of Arnpl.i.cant + _ft . �;
Ac1dr. ess , e:', Telephone
2 , Owner. of Proffer. t.y
Address ; T_^ _ _ `telephone
3 , Status of; AtPr�la.ca»t. ; Ol;lnelr. Contract Purchaser
Iaessee Other (e:,plain i_ )
4 . Pa r. c e 1 1.dent i.f icat.a on ; Zon.i.n c lfa � S heet,
� � � ,
Zoning District s)
Street Address r�Q
5 , Compliance' with Zoni.nu ; }a .i.st,i D y Proposed
Use of Structure/Property
Size of Structure (scq , ft .
)
Building height
Building Coverage
Setbacks - front
/ - ,side
{a. - rear ,
Lot Size
Frontage _
Floor Area Ratio _
% Open Space
Parking spaces
Loading Spaces
signs '
Fill (volume & location) —�
6., 'Mar. rati,�7e Description of Proposed Work• _Pr_o_j_ecct, t (Use
additi,dnal sheets if necessary) CU±. 0 , f, 'k d /Z"*
7 , Attached Plans ; Sketch Plan Site Plan
8 , Cert'ificat.ion ; x hereby certify that the •ih�ormation, oontained
herein is true and accurate to the best of my knowledge ,
Date ; Applicant ' s Signature ;
THIS - SECTION~FOR�OFrICIAL, USE ONLY!
Z Approved as presented
Denled as presented ,
Reason for Denial ;
Y
Signature of Building :inspector. , Date, �'I
' LAFARGE CORPORATION
NORTHEAST CEMENT
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CONNECTICUT-MASSACHUSETTS-NEW HAMPSHIRE-NEW YORK-RHODE ISLAND-VERMONT
617-492-3864 800-942-4202
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