35-258 (5) i
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PERMIT APPLICATION CHECK LIST
PAGE S� PLOT ZONE � f l ES NO DATE
ZONING FORM APPLICATION
2 . PERMIT I
3 . OW O L%
3 S
NEW S
6 , CURB CUT
L WATER
8 . REMODELTNG
9 , ADDITION
0 , ACCESSORY C
11 . SIGN / AWNING
12 , PEBMIT FEE - MONEY 0 DER; �dT-�' No
3 . SPEC IAL ER�IT SJ�UIREQ---WITH DEED IF APPLICABLE
4 . UNDER E - CMR 780
5 . FORM A
6 , FILL
COMMENTS : c 2 Pin, t' ' l Auk D
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. �} Alterations
NORTHAMPTON, MASS. 19 �5M Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location p Lot No.
2. Owner's f6 name ..'��� .?� ��`;'rY { -a Addressc �`d�
3. Builder's name �/C� S a " - _ Address ,/ ✓ C e-*r
Mass.Construction Supervisor's License No. Expiration Date _T �V_z
4. Addition
5. Alteration t �� IP.a'`c<} i✓4 eke - su�� ��'A�'d✓ ��?�c"
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 t1
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.
V Signature of responsible app icant
Remarks /�
A
004084
Date Filed J�u � /9`i
-.�� _ File No.
ZONING PERMIT APPLICATION
1 . Name of Applicant: C/E`t~�i �°
Address :_ ° o✓ Telephone:
Owner of Property:
Address : . < r , A, , ' f Telephone:
tatus of Applicant: owner contract Purchaser
Lessee Other (explain )
4 . Parcel Identification: Zoning Map Sheet# Parcel# �d
zoning District(s) (include over ay )
Street Address
Required
Existing Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
°-Bldg. Coverage (Footprint)
Setbacks - front $
- side L: �O R: L: R:
- rear
Lot size
Frontagie.
Floor Area Ratio
oOpen Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6 . Narrative Description.?f Propos d Wok Project: (Use additional sheets
if necessary) r< `
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X dP
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 knowled e. '
1
Date: Applicant's Signatur -+'
THIS SECTION FOR OFFICIAL S ONLY:
�Approved as presented/based on information presented
Denied as presented--Reason:
special' Permit and/or Site Plan Required:
Finding Re wired: Variance Required:
s f,
S. gnature o uzlding Inspector
NOTE: issuance of a zoning permit does not retlove an applicant's burden to comply with all zoning roquiroments and obtaln all required pormits
from tho Board of Health,consorvation commission, Doparlmont of Public Works and otltor applicablo permit granting nuthoritlos.
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