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D1.1MATM8INT 01+ DUIGDINO INSP-MYNONS — r
• INSP6C1'OR 212 lYtain Street A2u�iicipal 13ulldin� ''
Northampton, TN1a8 s, 01000
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 CI'T'Y OF NORTHAMPTON.
BEING A•HOM5OWNER AND NOT A PROFESSIONAL CONTRACTOR IN NO WAY
ABSOLVES ME OF ANY RESPONSIBILITY TO INSURE THAT ALL FACFTS-
OF THE RULES AND REGULATIONS ARE COMPLIED WITH.
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Date Filed — - File No',
. ZON'NG Z Itrd1:T APPLICATION
7,0 ni11CJ ord111L11)CO SCJCti.On 10 . 2
] Name of Anl.i.cant ; �
Address ; i
i• c '�ele hone ;
rn p
2 , Owner. of Property
Address ; T� T Telephone ;
3 , St�atus, oi' AIZ01 a.c<�nt: ; o',mer _Contract Purchaser
Lessee Other (e.xplai.n __ )
q , Parcel Identi-f'ication ; Zon,i Map Sheet,_ Parcel#
zoning District; (s)
Street Address
5 , Compliance' with zoninU ; r �istin _ Proposed
Use of Structure/Property C'VA G
Size of Structure (sq . ft , )
Building height �-
k Building coverage
Setbacks - front
side _.
{a. - rear ��+r7 ZE -;T
` Lot Size —°
Frontage
Floor Area Ratio
°s Open Space
Parking spaces
Loading Spaces
Signs '
Fill (volume & Location)
6., Narrati�ie Description of 'P r. onos0d Work Pro ect ; (Use ,
additi,dnal sheets if necessary) �s
7 . Attached Plans ; Sketch Plan Site Plan
8 , certlfiea�ion ; T hereby certify that the 'irt axmation, contained
herein is true and accurate to the best of my owledge ,
Date ; Applicant ' s signature ;
THIS - SECTION CTIONFOR OFFICIAL USE ONLY:- - - - _
✓`-'Approved as presented
Denied as presented
Reason for Denial ;
Signature Of Building :[nspeCtor'- Date. �/
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Miscellaneous Additions,Repairs,Alterations,etc. T 1.No. Alterations
go NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location �� 7� nrru1 S A jD alt, I�V1i4S5 Lot No. ,� y
2. Owner's name 0�y ?. l FACT u-y)mn Address rWS ,R , /Ui'1I' uK
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
Alterft6op
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:- /00
The undersigned certifies that the above statements are true to the best of his, her
knowle ge and belief.
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Signature of responsible applicant
Remarks
PHINT^SHOP
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