29-098 (3) PERMIT APPLICATION CHECK LIST
PAGE Aq PLOT ZONE 3q ' �� 'sa�� ^� ' ES NO DATE
ZONING FORM C IO N
1I t6
2 , PERMIT I
3 OWNER
3 SETS OF PLANS /PLOT PLAN- -
NEW S
6 CU BB CUT
WATER
8 , REMODELING
9 , ADDITION
0 . ACCESSORY
11 . SIGN / AWNING
2 ERMIT FEE - CHECK ONLY - MONEY ORDER
3 , SPECIAL PERMIT REQUIRED IF APPLICABLE
4 , UNDER S - CMR 780
5 FORM A
6 , FrLL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. -S -c% � Alterations
a NORTHAMPTON, MASS._ ^'4V / 9 19-� Additions
APPLICATION FOR PERMIT TO ALTER Repair
r
Garage
1. Location Lot No.
2. Owner's name "? l V .� Address 3 9 /S fc Z,6°fv W✓7 0,
3. Builder's name T)lq V I Ta r�` 0uj t-)F-r-rX Address
Mass.Construction Supervisor's License No. O S 913,-2, Expiration Date_ 3-/o -p�
4. Addition
5. Alteration � � .-.72A IFa0W /Yl/ 23A.5,5 /IL5 /7 l tIz z'A
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:- ' �y,2 �, 0O
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
ature of responsible app,icant
Remarks
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Date Filed M1q. File No.
ZONING PERMIT APPLICATION
I . Name of Applicant:
Address:_/ �, f�—,T)tr 4-�R,-kz Telephone:
2 . Owner of Property:
Address: ' ° ;`'t:°1'� h' ai�ac�, +R. Telephone:
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain )
4 . Parcel Identification: Zoning Map Sheet# Jq Parcel# q6 .
Zoning District(s) (include o erlays) ( ice
Street Address All. q
Required
5. Exis-ti'ng Proposed by Zoning
Use of Structure/Property
(if project is only interior wor , &kip #6)
Building height
%Bldg. Coverage (Footprint)
Setbacks - front
- side L: R: R:
- rear
Lot size 14000
Frontage.
Floor Area Ratio
. %Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6. Narrative DescriptionProposed Work/Project: (Use additional sheets
if necessary)
/=ul �A�h rhoan iiy �34.565 A115,vI7 W -rA
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: 1,1-24y iq - 9 Applicant's Signature:
THIS BECTION FOR OFFICIAL USE ONLX:
✓Approved as presented/based on information presented
Denied as presented--Reason:
Special.* Permit and/or Site Plan Required:
'nd ng Req red: Variance Required:
S. gnatur Building I pector ate
NOTE: issuance of a zoning permit does not reuove an applicant's burden to comply Wiut all zoning requirements and obtain all required permits
from the Board of Health,conservation commission, Department of Public Works and ouior applicable permit granting avthorluos.
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