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g Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. S 3/S' Alterations
a NORTHAMPTON, MASS. /0 /� 19� Additions
APPLICATION FOR PERMIT TO ALTER Repair
r
Garage
1. Location I �l" ��2nw� n Lot No.
2. Owner's name oe_ 1/ii►1,r` Address I
3. Builder's name LL4b4 Address W �1 env► . er
Mass.Conswction Supervisor's Lic se No. Expiration Date
4. Addition
5. Alteration
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
_V_
13. Siding house
14. Estimated cost:- o
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
SLg ure of responsible app,icant
Remarks
10. Do any signs exist on the property? YES NO
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES NO
IF YES, describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This column to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
of -Parking spaces
f of Loading Docks
Fill:
4v01-dme--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: APPLICANT's SIGNATUREZ
NOTE: Issunnoe of a zoning
g permit does not relieve an ap lioan urden to comply aivltlt
zoning requirements and obtain all required permits from the Ord of Health, Conservation
Commission, Department of Publio Works and other applicable permit granting authoritles.r"
" FILE #
-
File No. �1x 6
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: 410 rh,Telephone:
2. Owner of Property: o�i�•
Address:� � u R� Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# Parcel# District(s): P
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property �"fl7 �
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/Vadance/Finding ever been issued for/on the site?
NO DON'T KNOW YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW 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: -
ADDRESS/PHONE•
PROPERTY LOCATION: 1W Z
MAP ,-56 PARCEL: ZONE.
THIS SECTION FOR.OFFICIAL USE ONLY:
PERAUT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZOMNG FORM MLED OUT
lRyiilding Permit Filled mit
FPp Paid
Type of Constnirfinn-
Rt-rrindeling Interior
Addition t;Fjr*.,Rfln2
TI//FOLLOWING ACTION HAS BEEN TARN ON THIS AP ICATION: `.
�V 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
!P ro m,apvat' o
Signature of Building for Date
NOTE:Issuanoe of a zoning permit does not relieve an appiioant's burden to oomply with all
_ zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applionble permit granting authorltles.
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