36-255 (2) PERMIT APPLICATIO CHECK LIST
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PA1aE -'A" ZONE '' YES NO DAT E
1 . ZONINQ FQ.RM AEPLICATION,
2 .
3 . OWNER OCCUPANT STATEMENT # IF NO
4 . 3 SETS 0 S P
5 , NEW CONSTRUCTION
6 . CURB CUT
7 . WATER AVAILABILITY 0 S
8 . REMODELING INTERIOR
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 . SIGN / AWNI
12 . PERMIT FE L — MONEY 0 D ,
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 — CMR 780
15 . FORM A
16 , FILL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No:�8 V w? 1 Alterations
a NORTHAMPTON, MASS. S-e-,,� .2 19 / Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location (a ,- I D6 c- Lot No.
2. Owner's name 4 C'.3'PFXII LZ L- Address_ 7
3. Builder's name ��t � y�,C�/r'S/�/ �C, Address, do,< �C1�- y�' `Jv e������v
Mass.Construction Supervisor's License No. Di 7 jf'�� Expiration Date 4-&.1'
4. Addition
5. Alteration _
6. New4amtir LD2EZi<i� !�(X 6 /2X /7 /,V X /Z
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 a 6 ` -1 L FT 7- 0 Q 7- ij 4 Cc--xw 406 Z:Ws?'
12. Type of roof
13. Siding house
14. Estimated cost:-
�o2SG�c'. mza
The undersigned certifies that the above statements are true to the best of his, her
Knowledge and]belief. l
Signature o responsible appicani
I
Remarks
001
Cali
�E' /`� File No.
Date Filed
ZONING PERMIT APPLICATION (§10 . 2)
1 . Name of Applicant:
Address : d- yy Ab lend/,,/v A., T I e p h o n e: 5-�f,y VC)d.)L—
2 . owner of Property: ;Sc�N ,� S`T��N �c•
Address 10106r- ,CP Telephone : 5-TC .77/_3
/tilo..-'T 1 rfi•�"1 n1
3 . Status of Applicant: Owner Contract Purchaser
Lessee y, Other (explain :
4 . Parcel Identification: Zoning Map Sheet// p arcel#
Zoning District (s) (includes overt s)
Street Address (�5 if V141-1 AZICC.
Required
5. Existing Pro nosed by Zoning
Use of Structure/Property c--�/De_6ec : 1 12�
(if project is only interior work, skip to 6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - frontCl�
side L: 3o R: L: a(,, R: yo
- 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) ) 1-5;-J ,_-37- slbc- as-E;-3/DES Cg q" —14 PGO c S/pf�
.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 .
�J �
Date : /��3 Applicant's Signature: /�C .cam"
THIS SECTION FOR OFFICIAL USzl LY:
Approved as presented/based on information presented
Denied as presented--Reason :
S cial" Per ' t and/or Site Plan Required:
i n R egfql r,,fd: Variance Required,
Q0
S natu of Bui ector ate
NOTE: Issu of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required pormfts
from the Board of Health, Conservation Commission, Depaitmord of Public Works and other applicable permit granting authorities.
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