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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 7_ �� > Alterations
as"""PTO1 NORTHAMPTON, MASS. (0 19 q2 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location --21' 12�cir��.�a4af'��ic Lot No.
2. Owner's name :�t '7�?f� /Q , Address___—J, Tea
3. Builder's name /i _. ��� n .e Address y5W j .r.�e z- "•Y� t'LLrz ��` � �e�r1yt
Mass.Construction Supervisor's License No. O5 9 /3 _Expiration Date
4. Addition
5. Alteration v rr
6. New Porch _
7. Is existing building to be demolished? T_
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:- ,11O
sS,od
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature ojresponsible app,icant
Remarks '
904 0015 Date Filed_ �,3
File No.
ZONING PERMIT APPLICATION (§10 . 2)
1. Name of Applicant:
Address : ? Telephone: -. 7�
2 . Owner of Property: -27e.s,. ,z �, l�
Address : y J, �,�.,.,,,...� � ,�'.r$ ,r" ^o, r. Telephone:_ -5�6 -d3 W
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# Parcel#
Zoning District(s) (include overlays) VA-24 t,/j /�'
Street Address
Required
5. Existincl Proposed by-Zoning
Use of Structure/Property �c
(if project is only interio work, skip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
- side L: R: L:
- 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)
7 . Attached Plans : tZ'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: ( /9 5 Applicant's Signature :
THIS SECTION FOR OFFICIAL USE ONLY:
Approved as presented/based on information p resented
Denied as presented--Reason:
acl' Permit and/or Site Plan Required :
g Re it Variance Required:
f B i1d ' ctor 4 a
NOTE: Issuance of a zoning permit does not relfove an applicant's burden to comply witli all zoning requirements and obtain all required permits
from tho Board of Health, Conservation Commission, Department of Public Works and other applicable permit granting authorities.
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PERMIT APPLICATION CHECK LIST
A
PAGE Pt OT C?ZQNE L> ��Ijr ES NO DATE
1 , ZONINQ FORM IC IO "
2 . PERMIT A PPLICAJION
3 . OWNER CC P N 0
3 SETS OF S P L �
5 . NEW CONSTRUCTION
6 . CURB CUT
7 . WATER
8 . REMODELING
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 . SIGN AWNING
12 , PERMIT FEE - ) ONLY - 'e2 5___
13 . SPECIAL PERMIT REQUIRED WIIH DEED IF APPLICABL
14 . UNDER SECTION 127 - C R 780
15 . FORM
16 . FILL
COMMENTS : �-
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