36-103 (5) PERMIT APPLICATION CHECK LIST
p E 3(o PLOT P5 ZONE WZGL_ ES DAI`'C
ZONING
2 . PERMIT APPLI 3 . OWNER OCCUPANT IF NOT
4 . 3 SETS OF PL
NEW CONSTRUCTION
6 . CURB CUT
7 WATER S
8 . REMODELING
9 , ADDITION
10 . ACCESSORY STRUCTURE
11 , SIGN / AWNING
2 , P ERM T FEE - C I a , �
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 , UNDER SEC ION - C R 780
15 . FORM A
16 , FILL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.X"—a2 y� Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location y ° pp � �i�N1 Q� Lot No.
2. Owner's name I��e�b c ,A S�_ Address
3. Builder's name P� Address
Mass.Construction Supervisors License No. /'U(Z– C 9 Expiration Date
(`4. Addition
'`5 _Alteration
6. New Porch
7. Is existing building to be demolished?
S. Repair after the fire
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof
Siding house
M. Estimated cost:-
�yr360
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Sign �reqf s ponsible app icanl
Remarks
Date Filed File No.
ZONING PERMIT APPLICATION
1 .� Name of Applicant: 6 h
/
Address:— Telephone:
('2) Owner of Property:_0&1 .
/ Address : Telephone:
Status of Applicant: Owner ' contract Purchaser
Lessee Other (explain )
4 . Parcel Identification: Zoning Map Sheet 3(o Parcel# 103. r
Zoning District(s) (include over yS) J
Street Address `/ z
Required
5. Existinq Proposed by Zonin
Use of Structure/Property {1�l
(if project is only interior workJ sk p to ` 6)
Building height
oBldg. Coverage (Footprint)
setbacks - front
- side L: R: --L:—R '
- rear
Lot size 17 06
Frontage.
Floor Area Ratio
%Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
signs
Fill (volume & location)
i
% 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: Applicant's Signature:
THIS SECTION FOR OFFICIAL USE NLY: -
Approved as presented/based on information presented
Denied as presented--Reason:
ecial' grmit and/or Site Plan Required:
F' in kuired: Variance Required:
-- ��
7cl 7S
gn e of Buzl Inspector ' at
NOTE: Issuance of a zoning permit does not tellove an applicant`s burden to comply Willi all zoning roquiroments and obtain all required pormfts
from tho Board of Health,Conservation Commission, Dopaitmant of Public Works and otlior applicablo permit orantinu authoritios.
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