35-246 PERMIT APPLICATION CHECK LIST
PAGE _ PLOT 4r- ZONE S YES NO DATE
La.dysl i pp�.r- L ,�. - _
1 . ZONING FORM APPLICATION �' - 9
2 . PERMIT APPLICATION
3 . OWNER OCCUPANT LIC , #-- IF NO 1 0 a L-
3 SETS OF -PLANS PLAN
5 . NEW CONSTRUCTION-- -
6 . CURB C
7 . WATER V IL I IT FORMS-
8 . REMODELING INTERIOR
9 . ADDITIO
10 . ACCESSORY STRUCTURE
11 . SIGN AWNING c3 7
2 . PERMIT FEE - CHECK ONLY - MONEY ORDER lol p
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION - 127 - CMR 780
15 . FORM A
16 FILL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. s Alterations
soNORTHAMPTON, MASS. -c�- 19 Additions
-APPLICATION FOR PERMIT TO ALTER Repair
i
Garage
1. Location '' t..�< �� 5�t G'� �� �"� Lot No.
2. Owner's name / ��' 'Y` Lam'6,� L�/ic' Address �hJ/Il' � �� /1�c7�G=uP X14.
3. Builder's name 13!I ID C le Address f/ Apleer l i-V i?,C o'x'. ! n7 Z e,c.1� I/Ir "^c,,
Mass.Construction Supervisor's License No. � 5 0 y Expiration Date
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 S1 r l r t 5'
13. Siding house
14. Estimated cost:-'� y/7 p p
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible app,icant
Remarks
Date Filed �y S - 9'3 00076 I File No. fir;- a46
ZONING PERMIT APPLICATION (510 . 2) p
1. Name of Applicant: 1.3;11 1plc�l"sa� - r
Address : -j y241r2le, Telephone: &C- r fr/6-s-
2 . Owner of Property:
Address: C_ Telephone: 5FE- yc' yi
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain: 1.r )
4 . Parcel Identification: Zoning Map sheet# 3 Parcel#
Zoning District(s) (include overlays) S
Street Address '
Required
5. Existinct Proposed —by Zoning
Use of Structure/Property osFc("rte
(if project is only interior work, skip to #6)
Building height
%B1dg. 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 Works Pr,�ject: (Use additional ,sheets
if neces ark) S�'':d' c�x�57�i�5 ius ate( �E S'Li�r�s ^Z
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 knowledge.
Date:� � l� 3 Applicant' s Signature: ---
- - - - -THIS SECTION FOR OFFICIAL USE ONLY! `
Z Approved as presented/based on information presented ,
Denied as presented--Reason: k_
Special Permit and/or Site Plan Required: p_ -5;js
F ndi Required: variance Required: x
� 7J
Signa,tKre of Building Inspector .� Date
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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