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PERMIT APPLICA(/TION C`H'EC�K� LIST
'YES NO DATE
1 . ZQUING FORM PLI ION
2 . PgRMIT. APPLICATION
3 . OWNER OCCUPANT STATEMENT # IF NOT
4 . 3 SETS OF PLANS OT PLAN
5 . NEW CONSTRUCTION
6 . CURB CU
7 . WATER VAI I T FORMS
8 . REMODELING INTERIOR
9 . ADDITIO
10 . ACCESSORY STRUCTURE
11 . SIG ��jj
1 2 . PERMI FE - C ONLY - MONEY O DER V`�' .'' .
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��[���b Alterations Vii' !L47 ,' deck-
NORTHAMPTON, MASS. 19 Additions
' APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location rri!l/�Ge4� �'�1l�cC�- t Lot No.
2. Owner's name 9 0twi lev q-i l 1 Address q5 �-0 t✓' fimn' t-e j le r" '/Z
3. Builder's name Address
w,
Mass.Construction Supervisor's License No. ° Expiration Date
4. Addition
5. Alteration �l�. r G?� dti 1 �� C�-� 4�� � 1 7i (�eL
«
6. New Porch D-eLAC, O o l f' rlo L V`ea
7. Is existing building to be demolished? 0
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:- � ,r
/ ��
! f The undersigndce s that the above statements are we to the best of his, her
U
knowledge
gnature of r.sponslble app«icant
Remarks
• 00024 Date Filed 4 `j File No.
ZONING PERMIT APPLICATION
1. Name of Applicant: sh';i G,"o
Address S �_�1, �t t ft�'�tr�- 'i E'r d.r C Fly d Telephone:
2 . Owner of Property:Address : Telephone:
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain )
4 . Parcel Identification: Zoning Map Sheet# 3(o Parcel
#
Zoning District(s) (include over s)
s C.tl '
Street Address ,Y4
Required
5 . Existing Proposed bv Zonin
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front ? ?�
- side L: R: L: R:
- ream, - ,
Lot size i Loo
Frontage,
Floor Area Ratio
%Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6. Narrative Description of Proposed Work/Project: , (Use additional sheets
if necessary) R� o %be,- ; I.1 �'! ' •- �
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y
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7. Attached Plans: 1,-' Sketch Plan Site Plan
8 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowl e).
Date: ` Applicant's Signature'
THIS SECTION FOR OFFICIAL USE
!/Approved as presented/based on information presented
Denied as presented--Reason:
S cial' Permit and/or Site Plan Required:
'n 'ng u ' ed: Variance Required:'817 gnat f B _._ �ncJ- I�tspector at
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 ft Board of Health, Conservation Commission, Department of Public Works and other applicable permit granting authorities.
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