36-099 (3) PERMIT APPLICATION CHECK LIST
PAGE, PLOT ZONE Cl A c- i4l Pi C YES NO DATE
ZONING FORM APPLICATION N- 2 C/- 1,113
2 . PERMIT APPLICATION
3 . OWNER OCCUPANT EMENT LIC . 0 IF NOT W O/ S 1 :3 3 L'
4 . 3 SETS OF NS /PLOT PLAN
5 NEW CONSTRUCTION
6 . CURB CUT
7 . WATER VAILABI IT S
8 . REMODELING INTERIOR
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 . SIGN AWNING /
-3 J L�
2 . PERMIT FEE - CHECK ONLY - MONEY ORDER- 0-
3 . SPECIAL UI D WITH DEED IF APPLICABLE
14 , UNDE R SECTION 127 - CHR 780
15 . FORM
16 . FILL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
a Garage
1. Location C l j 7 Lot No.
2. Owner's name z: Address
3. Builder's name :7-1-1 --, /,- Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
7
5. Alteration //J
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:-
co -CIO
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Sigtiire of responsible app,icant
Remarks
Date Filed_..
ZONING PERMIT APPLICATION (910 . 2) File No. �3c
1 . Name of Applicant :
Address : —Telephone :
Z,
2 . Owner of Property:_ !a *&-;;ox,) t K ee
Address :_ rV1 Telephone :
3 . Status of Applicant : Owner Contract Purchaser
Lessee Other (explain : 11•-je-I 44 C 7100
4 . Parcel Identification : Zoning Map Sheet# _136 Parcel# 905'
Zoning District (s) ( include overlays) 0 A
Street Address gel,
Required
5 . Existina Proposed - by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%Bldg . Coverage (Footprint)
Setbacks - front
- side L: _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)
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 : V/1r 02 Applicant' s Signature : L 4
- - - - I- - - - - - - - - - - - - - - - - - - - - - - -
THIS SECTION FOR OFFICIAL U E 0 LY t
0 1
V�Aprproved as presented/based on information presented
Denied as presented—Reason :
Special' Permit and/or Site Plan Required ;
Finding Reqpired : Variance Required :
gag n
6- of nspector 'Elate
- �a
NOTE: issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning roquiroments and obtain all required porinits
from the Board of Health, Consorvation Commission, Dopattinont of Public Works and other applicable pornift granting authorillos.
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