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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location �'/2 D/ ! 1,L d9L'1i L n tr/' U2' Lot No.
2. Owner's name �C/ (r {�I C 4f/�� Address (�'Z ft�� Svc P(,�'/t �" 7 Cf`
3. Builder's name ,��y E�&N) R 06'F1I"G Address .2 13A16-6-
Mass.Construction Supervisor's License No. � _>�l"�,`7 Expiration Date
4. Addition /
Alteration R&G' F `f) 12 h (S I (/y 6
6. New Porch
?. 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:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
§tgnatu4lof responsible ap ,icant
Remarks
10 Do any signs exist on the property? YES NO-----,----
O ____
` IF YES, describe size, type and Iocabom
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 MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This corn to ba filled in
by the Building Dcpartm�nnt
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 narking)
# bf -Parking spaces
`
of Loading Docks
Fill:
-�vol-lime -& location)
13 . Certification : I hereby certify that the information contained herein
is true and accurate to the best of my knowledge ._
DATE: PPLICANT's SIGNATURE
NOTE: 113 nnoe of a Xonino permit does not relieve an�applioant33 Yurden to oomply with all
Zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Pubiio Works and other applionble permit granting authorities_
FILE I
E
File No.
ZONING PERMIT APPLICATION (§10y ��° `` ``
PLEASE TYPE OR PRINT ALL INFORMATION
Name of Applicant: ff, S1T rpt+,"d U�G'G'Fl z-6 f"G^n �iLq C Tc�2
Address: �� &; /Z166 S S 1 Telephone:
J2/ Owner of Property: r G—A(,,2g )�)641 y it Tj
Address: '�2 L�r/7y >��!'Pto2 %:4� Telephone:
;,3' Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): 0r'L(& �G�r i✓z<���Z 2
4. Street Address: 26 e c Q �L "Y
Parcel Id: Zoning Map# Parcel# �,� District(s):_ J
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
Existing Use of Structure/Property
6./ Description of Proposed UseNVork/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 PermitNadance/Finding ever been issued for/on the site?
NO ✓ DON'T KNOW YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO ✓ DON'T KNOW 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 # 960488
APPLICANT/CONTACT PERSON.
ADDRESS/PHONE: /!
PROPERTY LOCATION: t -
MAP PARCEL: �� ? ONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
7,ONTNC�FORM EHLED OUT
Fee Pnid
lRyiilding Permit Filled ntit
C,C P
Remodeling Interior
1 �
THF,FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION-
I/ 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 fr Cons rvation Commission
ignature of uil g Inspector Dal
NOTE:Issumn zoning permit does not relieve an applicants burden to oomply with all
zoning ements and obtain ail required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
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