29-068 (4) a
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No._51-8(1 Z3 k? Alterations
NORTHAMPTON, MASS. cicrntwu ..3/ 19-9-,q Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location !,s '-y to i , Lot No.
2. Owner's name c-)v\.�At Address 3SPi 2-.f A 1..1
3. Builder's name Address Z-L -I
�—
Mass.Construction Su rvisor's License No. ('7 //t� Expiration Date e) / � i92 7
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.' ype of roof
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
knowl belief.
0
Signature of responsible appi icant
Remarks
u
�•" � ' 003538
Date Filed _ File No.
ZONING PERMIT APPLICATION (§10. 2)
1. Name of Applicant:
Address :'
Telephone:
2 . Owner of Property: .
Address : Telephone:
3 . Status of Applicant: Owner "-° ontract Purchaser
Lessee /Other (explain:
4 . Parcel Identification: Zoning Map Sheet# _ mcelf
_,
Zoning Districts) (include erlay S
Street Address v ,
Required
5.
Existincr Pro osed by Zoning
Use of Structure/Property
h�= �
(if project is only interior work, skip to #6)
Building height +_
%Bldg . Coverage (Footprint)
Setbacks - front
side L: R: L: R•
- 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)
Y .
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 knowle
Date�D Applicant's Signature:
THIS SECTION FOR OFFICIAL USE U Y: r
-L�pproved as presented/based on information presented
Denied as presented--Reason:
Sp ec. l"' Permit and/or Site Plan Required:
n Requ ' d: Variance Required:
gnatur .0 ding Inspect D to
mit
NOTE: Issuance of a zoning per d no relieve an applicant's burden to comply with all zoning requirements and obtain all required permits
from the Board of Hoalth,Conservation Commission,Dopattmont of Public Works and other applicable permit granting aulhoritlos.
PERMIT APPLICATION CHECK LIST
PAGE. aq PLOT ZONE YES NO DATE
ZONING I IO
2 . PERMIT I
3 , OW NER OCCUPANT STAT E ENT (LIC \#)IF NO U
4 . 3 SET S /PLOT PLAN
NEW CONSTRUCTION
6 . CURB CUT
7 WATER S
8 . REMODELING
9 , ADDITION
10 . ACCESSORY STRUCTURE
11 . SIGN / AWNING
2 ER - MONEY ORDER .2131
13 , SPECI AL PERM�rUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION - C R 780
15 , FORM
16 , FILL
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