36-074 (4) � � o
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Zoning
"iscellaneous Additions,Repairs,Alterations,etc. Tel.No.cl�q—,n Alterations
NORTHAMPTON, MASS. = 19 qi� Additions
• Repair
• ' APPLICATION F4JR PERMIT TO ALTER
Garage
1. Location Lot No.
2. Owner's name Address
/S�n/ y n/c?GU
3. Builder's name UgE-�T / iOdQ'o Address L
i 'c G .Qsl��'c ���J ��`'adi3oi
Mass.Construction Supervisor's License No. Expiration Date 4,,!!�2,/s
S. Addition
5. Alteration
5. New Porch
7. Is existing building to be demolished?
S. Repair after the fire
9. Garage No.of cars Size
D. Method of heating
1. Distance to lot lines
2. Type of roof e d � � � ' ✓�', ��� �'
3. Siding house
4. Estimated cost-
The undersigned certifies that tVabotemcnis are true to the best of his, her
knowledge an tef.
Signature of responsible app icant
.emarks
10. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
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 col— to be filled in
by the Building Department
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 parking)
# of Parking spaces
# of Loading Docks
Fill:
(volume & location)
13 . Certification: I hereby certify that the information cont fined herein
is t e and accurate to the best of my knowle
DAT 1. � � APPLICANT'S SIGNATURE
N suanoe of a zoning permit does not relieve an ap iomnVa burden to comply with all
zonin. requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
1
Fi 1 e No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 1
Address: / Telephone: 77
2. Owner of Property:
Address: -PcL Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
1
4. Street Address: 3
Parcel Id: Zoning Map# / Parcel# District(s): �
(TO BE FILLED IN BY THE ILDI/NG DEPART�M`ENT)
Z IT
5. Existing Use of Structure/Property � dt
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
7. Attached Plans: Sketch Plan 68ite 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 Permit/Vadance/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 # i J 17
APPLICANT/CONTACT PERSOC 2 � � t
ADDRESS/PHONE: 1,57 IduAk Gt-�?� Q. ,C e111__,)ci
PROPERTY LOCATION: C' �z-e ✓ 0--`11 L-i-%'
MAP 37 PARCEL: ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Fee PAid
lRytilding Permit Filled nut
Addition to E isting GZ-
THE
OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION-
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 from Conservation Com ion
l
Signature of Building ffiVecto Dat
NOTE:lssuanoe of a zoning permit does not relieve an applicant's burden to comply with all
zoning requirements and obtain ail required permits from the Board of Health. Conservation
Commisslon, Department of Pubiio Works and other applioable permit granting authorities.
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