36-217 (2) ' 9
PERMIT APPLICATION CHECK LIST
PAGE PLOT 2-i j ZONE Se, /2. �t rl ,r S NO QATE
1 , ZONING FORM APPLICATION
2 ,
PERMIT APPLICATION �`-
3 OWNER OCCUPANT E i1 I - NO
r
4 . 3 SETS OF PLANS /PLOT PLAN --'
5 , NEW CONSTRUCTION
9 , CURS CUT
7, W619R AVAILABILITY FORMS
a , RE. ODELI G INTE.RTQR
9 . ADDITION__
1,0 , ACCESSORY STRUCTURE
11 . SIGN / AWNING
Av-
12 PERMIT FEE - CHECK ONLY - MONEY ORDER
13 , SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
,14 , UNDER SECTION 127 - CNR 780
15 FORM A
16 , FILL
COMMENTS ; -
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Zoning
S,t?
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
a NORTHAMPTON, MASS. ' - 19 g_3 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location 12 R l eC(-f L_IAA.)C Lot No.
2. Owners name I GS&r P14 'ielqu k-L Address 12- t lltC(f A le 7`tq/S t G11 7Z?
3. Builder's name ! I L Address-42,Y )O Tl f F/teLlt 5 RP, 012& c-LY ttd�f�
Mass.Construction Supervisor's License No. JO.3 f 24q Expiration Date
4. Addition ouef— �tS' TinJc +^Ck U) '1"14
2��;0� f1�t1i� `a=t�c�� �.1t1�t S
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 F eOA.2T 14 V
12. Type of roof 4 5 P i 1Z-T
13. Siding house CG 0 A-11 /� ►C3ft7='-I-)
14. Estimated cost-
y
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
' T o
Signature of resp nsible appicant
1
Remarks
r 0 0116 .
Date Filed �- _6? .S Im File No.
ZONING PERMIT APPLICATION (910 . 2)
1 . Name of Applicant: tiJriL
Address :_!FD`s AJQ2 1I F Pttt r 0pC-Ae-ZTelephone c
2 . owner of Property: 1C)s t--P14 C,) , 20gRr,4
Address , 1?- f3rpC g L11A;C-= .H etP-yf`CAJ Telephone
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain : )
4 . Parcel Identification: Zoning Map Sheet# Parcel# Z/ ,
Zoning District (s) (inclu(:�q oyerl ys) S
Street Address
Required
5 . Existing Proposed by Zoning
Use of Structure/Property `—(>E C:k 5> Jle�)O P>C? c
(if project is only interior work, skip to #6)
Building height
%B1dg. Coverage (Footprint)-_
Setbacks - front 1�F C?
- side L: .57 R: '5r3 R:
- rear — Y —Lot s i z e -- -70 C- .
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) Cv✓p�- �xrs r�n�T I�� K .�r�-t f�vU� /��J�
Se—eEr&l
7 . Attached Plans : r Sketch Plan }< Site Plan
S . Certification : I hereby certify, that the information contained herein
is true and accurate to the best of my knowledge .
Date : - Applicant ' s Signature :
- - - - - - - - - - S S EOTION I'OR OFFICIAL USE ONLYZIfH
pproved as presented/based on information presented
Denied as presented--Reason :
Special' Permit and/or Site Plan Required :
in ing qu ' red: Variance Required:
_S1gnati_(rcf 65T Buil Spector 1'1 '' D to
NOTE: issuance of a oning permit does not roilove an applicant's burden to comply with nil zoning roquiroments and obtain all required permits
from tho Board of Health, Consorvation Commission, Dapnitrnonl of Public Works and olhor applicablo pormil granting nulhorillos.
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