36-055 (4) PERMIT APPLICATION- CHECK LIST
PAGE PLOT s ZONE C�, } ? �G' �
YES NO DATE
1 . ZONING FORM APPLICATION 'f
2 . PERMIT APPLICATION `r
3 . OWNER OCCUPANT STATEMENT IC. # NOT
4 . 3 SETS OF PLANS OT PLAN
5 . NEW CONSTRUCTION
6 , CURB CU
7 . WATER AVAILABILITY FO
8 . REMODELING INTERIOR
9 . ADDITIO
10 . ACCESSORY STRUCTURE
11 . SIG AWNING
12 , PERMIT - LY - MONEY 0 DE /
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE -
14 . UNDER SECTION 127 - CMR 780
15 . FORM A
16 . FILL
COMMENTS ;
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Q Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. U Alterations
a NORTHAMPTON, MASS. _L.�19Additions
APPLICATION FOR P RMIT TO ALTER Repair
7- `�� Garage
1. Location �j / c e 77l>.E°'c"Ve-, Lot No.
2. Owner's name &gZ C L. it z m ce Address_ /Lt" XJC'
3. Builder'sname Address ::9ff;1y �Z SSEZI_ Sal
Mass.Construction Supervisor's License No. ._0 Z17 y o _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 lin�e-sJ,
12. Type of roof
t
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge an4 belief.
Signature of responsible appicant
Remarks
IV
U
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Date Filed !�
File No.
ZONING PERMIT APPLICATION (§10 . 2 )
1. Name of Applicant;
Address :._, Telephone :
2 . Owner of Property: �/ �" 671C'e
Address : �, f 6, Telephone :
3 . Status of Applicant:_owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# 36, Parcel# S_S ,
Zoning District (s) (include ovgrla s)
Street Address G ,
Required
5 . Existin ".Pro Dosed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg. Coverage (Footprint
Setbacks - front
side L: L:
rear
Lot size ,
Frontage
Floor Area Ratio
%Open Space (Lot area minus r
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6 . Narrative Description of Proposed Work Project : Use additional sheets
if necessary) ,� yL �'�?� <
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' s Signature:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
THIS SECTION FOR OFFICIAL USE ONLY:
ZApproved as presented/based on information presented
Denied as presented--Reason :
pecial' Permit and/or Site Plan Required :
i ing quired; _ Variance Required:
S gna u of Bu ' lei g,,...Ln-spector ate
NOTE: Issuance o 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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