35-247 (3) PERMIT APPLICATION CHECK LIST
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PAGE PLOT ZONE �� Cc � YES NO DATE {
-1 . ZONING ► /C
2 . PERMIT APPLICATION
3 . OWNER OCCUPANT STATEMENT IC.# IF NOT
4 . 3 SETS OF RLANS /PLOT PLAN
5 . NEW CONSTRUCTION
6 . CURB CU
7 . WATER V FORMS
8 . REMODELING I
9 . ADDITION
10 . ACCESSORY STRUCTURE---
1 . SIGN Z AWNING
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2 . PERMIT FEE — CHECK ONLY — MONEY ORDER
13 . SPECIAL PERMIT E UI ED WITH DEED IF APPLICABL
14 . UNDER SECTION 127 — CMR 780
15 . FORM
16 . FILL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19* Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location
_r, n rr' "'L; Lot No.
2. Owner's name 1C) 61 r r`, l Address
3. Builder's name i^ L7r n- rt" r,n__ Address "e X Q r s G lc't
Mass.Construction Supervisor's License No. � L� 5 f Expiration Date �' S
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. Type of roof
13. Siding house
14. Estimated cost:- 6
a
The undersigned certifies that the above statements are true to the best of his, her
knowledge and t
r
Signature of es onsible app lcan!
Remarks
Date Filed File No.
ZONING PERMIT APPLICATION (§10. 2)
1 . Name of Applicant: /�Ufn UT j fit >9�
Address: i�t i-,o r 11 �: �� A r _Telephone:
2 . Owner of Property: p �%
Address : Telephone:
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain:_ )
4 . Parcel Identification: Zo,- Sheet# 1 4 54- Parcel#
Zoning District(s) (include o,
Street Address 9
Required
5 . ,Pro nosed bV Zoning
Use of Structure/Prop, w'
(if project is only to
Building height
%Bldg. Coveracr
Setbacks
L: R.
Lot size
Frontage.
Floor Area
%Open Space .66t area mii,_
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6 . Narrative Description of Proposed Work/Project: (Use additional sheets
if necessary)
G Y
7 . Attached Plans: Sketch Plan Site Plan
8 . Certification: I hereby certify that the information containe herein
is true and accurate to the best of my knowledge.
Date: i� Appl icant s Signature
� � � ��
�7
J r THIS SECTION FOR OFFICIAL USE ONLY:
Approved as presented/based on information presented
Denied as presented--Reason:
AT ecial' Permit and/or Site Plan Required:
�f Fin ing Req • ed' Variance Require
S gnatur Build�jn - -n ector Da e
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits
from the Board of Health, Conservation Commission,Department of Public Works and other applicable permit granting authorities.
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