35-075 (2) PERMIT APPLICATION CHECK LIST
35- -_ o `7S
Yes No Date
1 . Zoning Form Application
2, Permit Application �-
3, Homeowner statement If a licable Lic . Il If not !i
A, 2 sets of plaos
5. Curb cut
6, Water Depar ,mant, ma_mn
7,- Permit fee - check only
8, Special Permit rgQ i e-d kith deed ifi anp I a
9, Under section 127 - CNR78 L
Form A
0, 0 o G ti A--,
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s X57.
(r�if� of wart 17millpfoll
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DEPARTMENT OF BUILDING INSPECTIONS _
212 11lain Street ' Municipal Building ��,M ,• rf
INSPECTOR Northampton, Mass. 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 CITY OF NORTHAMPTON.
BEING A HOMEOWNER 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.
Signature & Date
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 9 Alterations
;oat"""PTO� NORTHAMPTON, MASS. » 3 19Z,:�- Additions
e Repair Step
_ APPLICATION FOR PERMIT TO ALTER
f� Garage
1. Location p`� � l ,14 4`r P` W Lot No.
2. Owner's name Po &,et- ,�/�`�S'/��� /> Address
3. Builders name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration .z—A,7P�
6. New Porch
7. Is existing building to be demolished? ti cl
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:-
.
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
� a-
Signature of responsible applicant
Remarks
PHINUSHOP
Cp
a�
Date Filed ;��-�� ,-��_S- i"jr,Z
File No. - C- 17
C71 ZONING PERMIT APPLICATION (510.2) P; (Al P
1. Name of Applicant: c ���,c7
Address: �6 tZ /C?vr3 ty- / �j Telephone: _6 �y-x-30
- 1
2 . Owner of Property: tls Hrr)L-
Address: Telephone:
3 . Status of Applicant: c---Owner Contract Purchaser
Lessee other (explain: )
4. Parcel Identification: Zoning Map Sheet# Parcel# 0'75-
,
Zoning District(s) (includq over ys)
Street Address - -Y
Required
5. Existina Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg.Coverage (Footprint)
Setbacks - front
- side
_ - rear
Lot size
Frontage
Floor Area Ratio
%Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6. Narrative Description of Proposed Work/Project: (Use additional sheets
if necessary) �-
.0
7. Attached Plans: 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: J `�i J Applicant's Signature: j�� r � �tidrC
- - - - - - - - - - - - - - - - - - - - - - - - - - - - ---- - - - - - - -
THIS SECTION FOR OFFICIAL USE ONLY:
28
Approved as presented/based on information presented
Denied as presented
on fo A$nial:
S gnat °of -Bull-ding Inspector Date
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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