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Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. �" �d� � Alterations
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NORTHAMPTON, MASS. ' 19/1-.1 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location _30 f3/ cx/A//LC, lemma , `4dZ4,,^/CE` Lot No.
2. Owners name Adl�G&a Li �//✓ Address,50 i 166 A�/L[ � 222166
3. Builder's name T-ewygi&ad y v Address XUS, A/�T 1,V/Y,
Mass.Construction Supervisor's License No. Z9 y-L�T� Expiration Date
4. Addition
5. Alteration &N OAST AS��ifi'�T� T/f�fE !4� W &L11y
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 1p,
l
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
S oJresponsible aflpicant
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 MAST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This columm 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)
#1 of Parking spaces
# fof Loading Docks
Fill:
-4 vol-time -& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE:_ -!' APPLICANT I's SIGNATURE {
NOTE: Issuanoe of as zoning 9 Permit does not relieve an ly t'
app ans urden to comply with all
9 requirements and obtain all required permits from the Board of Health. Conservation _
Commission, Department of Publio Wor" and other applloable permit granting authorities.
ri.:Y. FILE #
File No. � ? 8
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: AllI CK
Address: ,� i o /f�blQl� 111IL4-. ./� �1�1. /7!'71 Telephone:
2. Owner of Property:
A
Address: 30 M&Y Alm &VI 69!! � Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map#.C;1?9 Parcel# 9 District(s): G�/f'
(TO BE FILLED IN BY TH BUILDING DEPARTMENT)
5. Existing Use of Structure/P rope tty��!f1f1Fi���-
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 -K YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW X 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 # ` Qs2
�'I V
N
P ,ICANT/COTACT PERSON: Lam( GG,tC
ADDRESS/PHONE:
PROPERTY LOCATION:
MAP PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Rnilding Permit Filled mit
t/
acv —
-Remodelin2 Interior
Addition to Existing
THE LLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION: <:
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 Conservation mmission
Signature of Bui ding Date
NOTE:1"uanoa of a zoning permit does not relieve an applioant's burden to comply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applicable permit granting authorttles.
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