36-189 (11) MAR 2s
Scale 1
Buts Pit Road
125'
F-40 5
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�`4 4-3
House
BreezEway &. 22.
-7 Garage
1
17' Piiret, 25iY
:3ept.ic 1 24'
Tank 17
2 C)'
30
Proposed
Leach Fields 40' Pool 24
(Approx)
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Sack Fence
102' 1 �a
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1-- 125,' Back Property Line
45'
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. c 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
a
Garage
1. Location Qd Lot No.
2. Owner's name Address
3. Builder's name Address --
Mass.Construction Supervisor's Licen No. tGl> 6 Expiration Date o2r, ---��
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 d J all
14. Estimated cost:- /�/c ��, ^
�� C�t� �v✓c� —
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
1 Signature of responsible app icant
Remarks
10. Do any signs exist 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 v�
IF YES,describe size, type and location:
11 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This Col.== to be filled in
by the Building Depastaent
Required
Existing Proposed By Zoning
Lot size j 1
Frontage
Setbacks
- side L: Z ZS�R: 22. L: SO R: Z�s'
- rear
O
Building height
Bldg Square footage 213 ? , �-
%Open Space:
(Lot area minus bldg
&paved parking) r—
#
.9f -Parking Spaces
f of Loading Docks
Fill:
4vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: APPLICANT's SIGNATURE �-2�-
NOTE: Issuance of a zoning permit does not relieve an appii ant's rden to oompty with all
zoning requirements and obtain all required permits from the Goa of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
1AAR Z 6 W6
Fi 1 e No.
PT OF St111 I)MIf
I'oRf----M i`l I 01 '"
."'`ING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR P=T ALL INFORMATION
1. Name of Applicant:
_._ -
Address: ae Telephone: �/i::�'
2. Owner of Property:_ L. s,.cx r- 4
Address: t'� �/� Telephone:
3. Status of Applicant: Owner _j�Contract Purchaser Lessee
Other (ex/plain):
4. Job Location:
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
S Existing Use of Structure/Property
6. Description of Proposed UseNdork/Project/Occupafion: (Use additional sheets if necessary):
T -
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special Permit/Variance/Finding ever been issued forlon the site?
NO DON'T KNOW ✓ YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW _ YES
IF YES: enter Book Page____ and/or Document# /
9. Does the site contain a brook, body of water or wetlands? NO DON'T 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)
FILE 1 960768
MAR 2 619%
r PPLICANVC04TA T PERSON:
PROPERTY LOCATION: `
MAP < PARCEL: ZZ,Z ZONE
THIS SECTION FOR�OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FITLED OUT
Fee Pnid
11itilding Permit Felled rint
Fee Pnid
NewCnngfrilction
�s
f
".
V
THE_F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
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 f Cons rvation Commi o
Signature of Building Inspector DATE -
NOTE:Issuanoe of as zoning permit does not relieve an applioant's burden to comply with all
zoning requirements and obtain all required permits from tha Board of Health, Conservation
Commission, Department of Public Works and other applioable permit granting authorities.
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