25A-079 (2) VALLEY HOME IMPROVEMENT, INC. JO8
320 Riverside Drive P.O. Box 60627 sHEETiJ ' ' OF
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NORTHAMPTON, MASSACHUSETTS 01060 CAL(:U�ATED Y DATE
TEL (413) 584-7522
FAX (413) 585.0820 CHEC D E, EPT GF BUILDNG INC � ,S DATE
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PRODUCT 204-1(Single GAeets)205-1(Padded)�®Inc.,Groton,Mass.01471.To Order PHONE TOLL FREE 1800-225b380
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No._ rr Alterations
a NORTHAMPTON, MASS. ��� 19_��, Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location �C�' 1=� 9 Lot No.
2. Owner's name Address a All c=
3. Builder's name ���"' Address 0 V �rzt�tb�
, 7
Mass.Construction Supervisor's License No. 0 Expiration Date 9
4. Addition _
5. Alteration �// f�/r 1 d W </ - Ar d C-
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 /
eta The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible appicant
Remarks
Y
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
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 Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
# of Parking Spaces
# of Loading Docks
Fill:
(volume & 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
NOTE: lauumnoe of a zoning permit does not relieve an applicants burden to oompty with all
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission, Department of Public Works and other applioable permit granting authorities.
FILE # ,
: f a
i L 2 I V% l r7
la� File No. �.=�,
'ART�'F�i�lks r i jr
. ,.. _aa- DOING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
I Address: - /'-1-Telephone: ��
�-t' 061
2. Owner o Property: ",7
Teleph G Address: ! /''
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): C ((LA �
4. Street Address:
Parcel Id: Zoning Map# f Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupabon: (Use additional sheets if necessary):
�o,�✓� �' /cam 7D f�jdwcr - �,/� o'�,ou�i i✓b(�,a/�-
/
7. Attached Plans: Skc 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 PermitNadance/Finding ever been issued for/on the site?
NO DON'T KNOW YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
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)
: 1 �} U4 96971
FILE # U%
MAR 2
DE APRI I T CT PERSON: Va' r��' ` ' lyA!
7,5 d
PROPERTY LOCATION:
MAP 5, PARCEL: el ZONE THIS SECTION FOR-OFFICIAL USE ONLY:
PERNIIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FT LED OUT �
Fee Pnid
'Riiilding Permit Filled Qvit
u`
Fee Pahl
Tyne of C'nnstnirtinn.
New Cnngtrivrtinn
Remndeling Tnterinr_�/ir�
AdAitinn to Existing
Ian lrlin2 Plane Tnelyide l-
Owner/(lrrn=ant .Statement n irense#; �O."
3 .Sets of Plans /Pint Plan
THE KILLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION-
J,
JV 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 from onservatio om iss'
Signature of Building ector
Da(e
NOTE:issuanoe of as zoning permit does not relieve an applicant's burden to comply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
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