25A-062 (5) 4
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PERMIT APPLICATION CHECK LIST
PAGE a - PLOT G:� ZONE O-t,6 -3 q. ES NO DATE
ZONI.NQ FORM 0
2 . PERMIT APPLICATION
3 , OWNER OCCUPANT STATEMENT / L IQ if I F NOT
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3 SETS OF PLANS /PLOT P! 8N
5 , NEW CONSLRUCTION
Q , CURB CUT
3 — VA198 AVAILABILITY FORMS
S , REMODELING INTERTOB
9 rTjoN
SIG INQ
L2� PERMIT FEE - CHECK ONLY - MONEY ORDER
13 , SPECIAL PESMITBEQUIRED WITH DEED IF APPLICABLE
h , UNDE-R SECTION J2 - CMR 80
15 FORMA
16 , FILL
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
ti NORTHAMPTON, MASS. -19z- Additions
i _ a
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location e Lot No.
2. Owners name Addressi
3. Builder's name oe '� Address �� U YV 1L $,
Mass.Construction Supervisor's License No. y s• Zle 11'5 IP Expiration Date 9'S
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
14. Estimated cost:- �3 F5
l
The undersigned cer ' '6stpat the abov tat ents are true to the best of his, her
knowledge and ief.
54� Z Sig natu e o responsible app,icant
Remarks
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1 FPS 1
Date Filed 1 � 001-L 4
File No,
ZONING PERMIT APPLICATION (§10 , 2 )
1
NZ i can
t:
Address : , Tale hone : S
2 . t y:
Address : _ �/ G o �,�, Telephone : -0 3
3 . Status of Applicant : Owner Contract Purchaser
Lessee Other (explain : )
4 . Parcel Identification: Zoning Map Sheet# ZL5 Parcel# ,
Zoning District (s) (includ overlqs) C.tP6
Street Address
Required
5 . Existinq A Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
- side L.: 1 L: R:
- 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 o roposed Work/Project : (Use additional sheets
if necessary) _
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
Date Applicants Signature :
THIS SECTION FOR OFFICIAL, USE ONLY: _
Approved as presented/based on information presented
Denied as presented--Reason :
Special' Permit and/or Site Plan Required
Findin Requ ' ed: • _ Variance Required :
MAY
ST
gna ure of Buildin Spector ? Date
NOTE: issuance of a zon permit does not roliova an applicant's burden to comply with all zoning requirements and obtain all required permits
from the Board of Health, Conservation Commission, Dopaitrnont of Public Works and other applicable permit granting authorities.
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