36-093 (3) a
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. � Alterations
1 NORTHAMPTON, MASS. 19` Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location Lot No.
2. Owner's name Address �� 2 /
3. Builder's name Address C' Fi�ze-,vc-
Mass.Construction Supervisor's L cense No. �Ja 715 Expiration Date 7
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 cos
The undersigned certifies that the above statements are true to the best of his, her
knowledge and 71 f/!%%%
Sig lure of responsible app,ican!
Remarks
10. Do any signs ebst 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.
s �z� to be im
by the Banding Depa-rt—t
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 contained herein
is true and accurate to the best of my kno ledge.
iDATE= 1-21� APPLICANT's SIGNATURE
NOTE: issue i2oe of s zoning permit does not relieve nn s 11oanY urden to oompty with all
zoning requirements and obtain call required permits from the rd of Health. conservation
Commission, Department of Publio Works and other c+pplionble permit granting eiuthorities.
FILE it
File No.
ZONING PERMIT APPLICATION (§10 .
P r,F.A.SF' TYPE OR P=T ALL =ORMATSON y �0`
1. Name of Applicant: Q ('9
Address: 70 / Telephone:
2. Owner of Property:
Address: �at?P„> � � � ,f,v Telephone:
3. Status of Applicant: Owner 1/ Contract Purchaser Lessee
Other(explain):
4. Street Address: � la2Pti C
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
�. Existing Use of Structure/Property
3. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
Lnswers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
Has a Special PermWariance/Finding ever been issued for/on the site?
NO DON'T KNOW YES IF YES,date issued:
lF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document#
i. Does the site contain a brook, body of water or wetlands? NO-4-1 DONT 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)_
vs
FILE #
0
APPLICANT/CONTACT PERSON- '-1 'JS/
ADDRESS/PHONE: G )
PROPERTY LOCATION:_ C Aw `
MAP 95 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FnRM FRIED MIT
Fee pflid
a
n
Addition fn FTkting
C l
T OLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION: .'
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 Cons ation Co ssion
Signature of Building Inspector Yate
NOTE:lssumnoa of to zoning permit does not relieve an applioanYs burden to oomply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
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