36-022 (2) PERMIT APPLICATION CRACK LIST
PAGE PLOT Z- 2-ZONE 6trGA- l/ 13 `� ` � YES NO DATE
1 . ZONING FORM APPLICATION
2 . PERMIT APPLICATION w.
3 . OWNER OCCUEANT STATEMENT LIC. # IF NOT
4 . 3 SETS OF PLANS OT PLAN
5 . NEW CONSTRUCTION
6 . CURB CU
7 . WATER VAIL BI IT FORMS
8 . REMODELING INTERIOR
9 . ADDITION
10 . ACCESSORY T UC U
11 . SIG AWNING
12 . PERMIT FE - CHECK ONLY - MONEY ORDER
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. Alterations
NORTHAMPTON, MASS. 19 Additions
ti
APPLICa ATION FOR PERMIT TO ALTER Repair
/� Garage
1. Location ,1J/,,yy�� /ice' i /x A Lot No.
2. Owner's name 11-1 7l c• i'!yt/r Address
�- r�
3. Builder's name /U. f ey,S�/. ✓��`''d�� � Address �G z�dle
Mass.Construction Supervisor's License No. Expiration Date -
4. Addition
5. Alteration a ee=-S /e D. csa .Pii�' 4, .-zit 4
6. New Porch
7. is existing building to be demolished?
S. 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 cosL- �
The undersigned certifies that the above statements are true to the best of his, her
knowledge and beli
a _ �` "
Signature of responsible app. an!
Remarks
� tT
Date Filed I�fN File No.
ZONING PERMIT APPLICATION (§i0. 2))
I . Name of Applicant: �« %� r/��5� �a-��-s,'7—
Address: I Telephone:
2 . Owner of Property: "-, ,
Address:- . 1,/, Telephone: -sue -�ys
3 . Status of Applicant: Owner ontract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# Parcel#
Zoriing District(s) (include o erlay
Street Address
Required
5 • Existing Proposed by Zoning
Use of Structure/P erty
(if project is only i terior work, skip to #6)
Building height
%B1dg. Coverage (Footp int)
Setbacks - front
side L: R:
- rear
Lot size
Frontage.
Floor Area Ratio
%Open Space (Lot ar a minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6 . Narrative Description of Proposed Work/Project: (Use additional sheets
if necessary) S ,
C
- e t
r
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:_ Applicant Is Signature:
THIS SECTION FOR OFFICIAL USE cN Y:
Z proved as presented/based on information presented
Denied as presented--Reason:
c.ia1. Per ' and/or Site Plan Required:
in 'ng Re u Variance Required: _
gnat r f Building Inspec or_ Elate
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 tho Board of Hoalth,Conservation commission, Department of Public Works and other applicable permit granting authorities.
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