36-082 (4) PERMIT APPLICATION CHECK LIST
. °'
PAGE PLOT F?,� ZONE �J YES NO DATE
1 , ZONING FORM APPLICATION
2 . PERMIT APPLICATION
3 . OWNER OCCUP NT S7ATEMENT LICA-- IF NO
4 . 3 SETS OF S pLq
5 . NEW CONSTRUCTION
6 . CURB CU
7 . WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 , SIGN AWNING
12 . PERMIT FE - C - MONEY ORDER
13 , SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - C R 780
15 . FORM
16 . FILL
COMMENTS :
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.( Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
a NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
2-37 Garage
1. Location �.5� �0h b Lot No.
2. Owner's name W'sNk1kcc Address_ f.
3. Builder's name a *Ir Address_ k tU C s
Mass.Construction Supervisor's License No." L+4 Lk ` _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
13. Siding house
14. Estimated cost:- -�t 00
The undersigned certifies that the above statements are true to the best of his, her
knowjpdkc and be
S gnature of responsible app,icanl
Remarks C �� —
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Date Filed File No.
ZONING PERMIT APPLICATION (§10 . 2)
1 . Name of Applie t, �^
Address : r Telephone :
2 . Owner of Property: ti' l
Address : `� Telephone :
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (expla ' n : )
4 . Parcel Identification: Zoning Map Sheet# Parcel#
Zoning District (s) (include o1vgrlays;) V
Street Address
Required
5 . Existing Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
- side L: "11--,,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 Work/Project : (Use additional sheets
if necessary)
P f ra KOn+
7
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 knowl e
Date : Applicant s Signature .—
THIS SECTION FOR OFFICIAL- G_SE ONLY:
Z Approved as presented/based on information presented
Denied as presented--Reason :
Special' Permit and/or Site Plan Required :
Finding Re uired: Variance Required:
h
Signature o uil ing Inspector a e
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 Hoolth, Conservation Commission, Department of Public Works and other applicable permit granting authorities.
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