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PERMIT APPLICATION CHECK LIST
Pty., Y S NO DATE
1
2
3 . OWNER C 0
3 PLAN
5 . NEW CONSTRUCTION
6 . CURB CUT
7 . WATER
8 r ,
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 . SIGN / AWNING
12 . PERMIT FEE — — MONEY OR ER s
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 2 — C R 780
15 . FORM
16 , FILL
COMMENTS:
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
a NORTHAMPTON, MASS. 2`2 L 19� Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location 4-/ 7 no r)>/ �ri &e- ry y✓`f�/r» 7`�� , Lot No.
2. Owner's name TLZI i 9/e,71 e Address -7 )U e-r U2-
3. Builder's name II a. /,ze" 22_' y ray�-3-n Address 0 y U �1�� aQ ' a
Mass.Construction Supervisor's License No. 0(,t-)300 Expiration Date
4. Addition -
5. Alteration ✓ P 1"'n
G
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:-
The undersigned certifies that the above statements are true to the best of his, her
( „V( knowledge and belief.
`G
AV-//
Signature of responsible app,ican!
Remarks G VI— 4./�
0 0 1 'i Date Filed
�
File No.
ZONING PERMIT APPLICATION (§10 , 2)
1 . Name of A pliclt: �� <S /c /L emu' //
Address . ,� - rub T lephone:
2 . owner of Prop rty:
Address : Telephone : z/ 7
3 . Status of Applicant : Owner Contract Purchaser
Lessee Other (explain : )
4 . Parcel Identification: Zoning Map Sheet# Z� Parcel# t� ,
Zoning District (s) ( '-n� ude overlays) a05
Street Address 1
Required
5 . Existinq Prong e b Zonin
Use of Structure/Property .
(if project is only interior work, skip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
- side L:
- 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/Prgject : (Use additional sheets
if necessary)- �,{'isJS�=,
4 , -(Z .,
7 . Attached Plans : Z,/Sketch Plan }z' °/ ite Plan
8 . Certification : I hereby certify that the information contained herein
is true and accurate to the best of my knowledge .
Date : `;�- Z� Applicant ' s Signature :
THIS SECTION FOR OFFICIAL USE ONLY:
r/Approved as presented/based on information presented
Denied as presented--Reason:
Special Permit and/or Site Plan Required :
nding R ired: - Varian c Require :
" \
S natu e uil ector ?/Dat
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 arid other applicable permit granting authorities.
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