25A-046 (13) VAJ
OFFICE OF THE
BUILDING INSPECTOR
i $
In accordance With Section 127 . 0 of tree hassachusetts State .
Building Code, 0�=L7 being a
Professional Engineer Architect' certify that the plans for
i' 'r� 'r7 ► �'�z�'+f 1C'�'y °j, ; E� ,;, -;. - �n� h a v e been prepared
under my supervision and to the best of my knowledge , such
plans conform to the provisions of said Code , all acceptable
engineering practices and all applicable law ordinances .
And, further , that I will comply with the requirements of
Section 127.2.2 for the structural portions of the building
and subldi.t reports to the Architect for inclusion in his
reports as required by Section 127 . 2 . 3 of the Code .
!v
Signature
Subscribed and sworn to before me this
day of l �il,�P 19 ��
otary Public
PRMLTP l 0 A U.—
My Commission Expires ATev LL
MY DOII MISSIon Marco 3fitio
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Zoning 's A
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
a NORTHAMPTON, MASS. 19 Additions c—!APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location Lot No.
2. Owner's name k j Address ..
3. Builder's name E Address
Mass.Construction Supervisor's License No. �1 a'1�> Expiration Date
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 n v1A
11. Distance to lot lines i
12. Type of roof
13. Siding house
14. Estimated cost:- coo
q�
The undersigned certifies that the above statements are true to the best of his, her
know edge and eli
Signature of responsible app,icanl
Remarks
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oolvy
Date Filed File No.
ZONING PERMIT APPLICATION (510 . 2)
1 . Name of Appl i a t: �p►tit�u. � � ,rte) l 1 , ��ti�
Address : Tale hone :
2 . owner of Property: C)�?C�
Address : . t , � r� , Telephon
3 . Status of Applicant: Owner V'—Contract Purchaser
Lessee Other (explain : )
4 . Parcel Identification: Zoning Map Sheet# T Parcel# 4� ,
Zoning District (s) (include over a s)
Street Address )`, � r� ,
Required
5 . Existincr Proposed b Zoning
Use of Structure/Property Ca '
(if project is only interior work, skip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
- side L: R: 10c) L: R:
- rear t
Lot size .
Frontage `1
Floor Area Ratio
%open Space (Lot area minus i
building and parking) -- �
Parking Spaces
Loading
Signs
Fill (volume & location)
6 . Narrative Description of Pr osed Work/Project, : (Use additional sheets
if necessary) — LIP, 1 c-• , ,C
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 knowle ge .
Dater Applicant' s Signature :
THIS SECTION FCR OFFICIAL USE ONLY: - _ r - - - - - -
"
Approved as presented
/based/
r based on information presented r
,
Denied as presented--Reason :
,E�pecial' Permit and/or Site Plan Required :
�'Fing ui e : _ Variance Required :
gnat e of Build ' pector j / '7 /Date
NOTE: Issuance of a zoning porrnit does not roliove nn applionnt's burdon to comply with nil zoning requirements and obtain all required permits
from tho Board of Hoallh, Consorvation Commission, Dcpartrnont of Public Works and olhor npplicnbio pormil grnnling oulhorilios.
PERMIT APPLICATION CHECK LIST
PAGE PLOT ZONE YES NO DATE
1 . ZONING FORM APPLICATION
2 . PERMIT APPLICATION Y�---
3 , OWNER OCCUPANT E LICJ IF NO
4 , 3 SETS OF S /PLOT P ✓ �'
5 , NEW CONSTRUCTION
6 , CURB CUT
7 , WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 , ADDITION
10 , ACCESSORY STRUCTURE
11 . SIGN WNING
12 , PERMIT FE - C - MONEY ORDER
L�
13 , SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 , FORM A
16 . FILL
COMMENTS :
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