36-133 HERMIT APPLICATION CHECK LIST
PAGE 3G PLOT I S-3Z ON ; . '`` Iq ES 0 DATE
1 . ZONING FORM APPLICATION
2 . PERMIT P C
3 . OWNER OCCUPANT STATEMENT LICA- IF NOT
4 . 3 SETS OF PLANS T PLAN
5 . NEW CONSTRUCTION
6 . CURB CU
7 . WATER I FORMS-
8 . REMODELIN INTERIOR
9 . ADDITION
10 . ACCESSORY T U U
11 . SIGN / AWNING
12 . ER E — O — MONEY ORDER
3�� Ci
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 — CMR 780
15 . FORM
16 . FILL
COMMENTS:
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y Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. fit/ Y r Alterations
NORTHAMPTON, MASS. 69 19_e Additions
' APPLICATION FOR PERMIT TO ALTER Repair
/� Garage
1. Location -f ��'�. f'e` -� � C, Lot No.
2. Owner's name A',5,r/ t= 1 z" ? S Address 3/,0 ,E�i?o4fCSj,bF Gyi2�L�it-5
3. Builder's name _2;?19r1 Address 7:�-,: 2� c 4
Mass.Construction Supervisor's License No. 7,4 9/F a-' Expiration Date P'//i/2:z
4. Addition eylxl h c.�le6 2 i X Z
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- X02 mss', G
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
rya
ignature of responsible app,icanc
Remarks
Date Filed 7
002806
File No.
ZONING PERMIT APPLICATION
1. Name of Applicant:_- ,9;,, ,j Ouir.� TT
Address: Te1ephone:
(2) Owner of Property:
Address : 4,. Telephone:
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain: )
4 , Parcel Identification: Zoning Map Sheet# 3(oo Parcel# / 3,
Zoning District(s) (include ove lays
Street Address 31
Required
5. Existincr Proposed by Z�o in
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
- side L: / R: t- R: X
- rear p
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)
y
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. G
Date: Applicant's Signature:
THIS SECTION FOR OFFICIAL sE ON
_L-"Approved as presented/based on information presented
Denied as presented--Reason:
Special• Permit nd/or Site Plan Required:
di, g Requi Varian a Required:
L
4ganatur4'bfbuildingInIns`pe r to
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 Health,Conservation Commission, Department of Public Works and other applicable permit granting authorities.
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