25A-110 (6) PERMIT APPLICATION CHECK LIST
PAGE 2K/-J-PLOT 116 ZONE ��A ��3 YES NO • DATE
1 . ZONING FORM APPLICATION Cry -!��
2 . PERMIT APPLICATION
3 . OWNER OCCUPANT STATEMENT LIC . # IF NOT
4 . 3 SETS OF PLANS PLOT PLAN
5 . NEW CONSTRUCTION
6 . CURB CUT
7 . WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 . SIGN AWNING
12 . PERMIT FEE - CHECK ONLY - MONEY ORDER 'tSZ- v
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. cc�� Alterations
NORTHAMPTON, MASS. Vv� ��, _19_1 . Additions
ti
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location Lot No.
2. Owner's name MfS ��- %� `' `T Address-3 �% 4c4 c
3. Builder's name f t--, {�� kL�_ Address It r
Mass.Construction Supervisors License No, C., F ` — _Expiration Date �. 7-
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 roofS;Tr>p �e� erg
13. Siding house
14. Estimated cost:- 3°�..
The undersigned certifies that the above statements are true to the best of his, her
knowledge and bel' f.
ignature of r sponsible app,icant
Remarks
4 U
si�Yti !r
Date Filedj.Y�� File No.
ZONING PERMIT APPLICATION (§10 . 2 )
1 . Name of Applicant; Aq kc
Address : Telephone : S 9- ,<
2 . Owner of Property: - Lrc. s.on c- k/r, 1
Address : 3 3 'Jr, //0V);," 4_dTelephone :
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain: �1 )
4 . Parcel Identification: Zoning Map Sheet# ZS4- Parcel# 110 ,
Zoning District (s) (include ov rlays) LC4
Street Address 3 ,
Required
5 . Existing Pro Dosed -- by Zonin
Use of Structure/Property
(if project is only interior work, s p tLb #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
- side L: R. 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 of Proposed Work/Project : (Use additional sheets
if necessary)
7 . Attached Plans : Sketch Plan Site Plan
8 . Certification : I hereby certify that the :information co tained herein
is true and accurate to the best of my knowledg .
Date : �/ a� Applicant' s Signatu
— — — — — — — — — — — — — — �,. — — — — — -
THIS SECTION FOR OFFICIAL USE LY:
-Approved as presented/based on information presented
Denied as presented--Reason :
Special' Permit and/or Site Plan Required :_
i ding R qu ' ed: Variance Required : _
-gnat of Bu ' g Inspector r ate
NOTE: Issuance of a 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 grantin47 authorities.
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