25A-182 (11) PERMIT APPLICATION CHECK LIST
PAGE �� PLOT °� ZONE Gl t, : YES DA
1 . ZONING FORM APPLICATION
2 . PERMIT APPLICATION1-�
3 . OWNER OCCUPANT STATEMENT LIC . # I NOT
4 . 3 SETS OF PLANS PLOT PL F'I0 C-
5 . NEW CONSTRUCTION
6 . CURB CU
7 . WATER AVAILABILITY FORMS-
8 . REMODELING INTERIOR
9 . ADDITIO
10 . ACCESSORY STRUCTURE
1 . SIG N / AWNING
12 . PERMIT FEE - CHECK ONLY - MONEY ORDER C?.
13 . SPECIAL PE RE UI ED 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. Alterations
a rNORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location 9�-� IZAUS74-71 4 If',;9:'_ Lot No.
2. Owner's name �n+D�E � ly—o,� / Address ���SaLC /� j���zL-
3. Builder's name G&&X� A.er/ia� /W44 Address /.9 2 4&sl- S'f
Mass.Construction Supervisor's License No. Q 16 7 8 $ Expiration Date
4. Addition /
5. Alteration ' iUDitl-6.efle1w1q Diioov w ,-l� iuSZc�A � S'�iF�.E'OGC__
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:-
� l
The undersigned certifies that the above statements are true to the best of his, her
knowledge and b ief.
Signature of responsible appticanl
Remarks
Window
Baseboard
Electric—�
Heater
20 ft
Bathroom
15 ft 15 ft
30 ft
® Single Duplex Outlet
■ Double Duplex Outlet
a Tele/Data Faceplate
■ Light switch
. 4 Fs�yy y
Date Filed '3" ZV- ci,3 v 000 ' File No. ,;i `^- / g'_
ZONING PERMIT APPLICATION (510 . 2) (1l
1. Name of Applicant: ,l,►u/
Address: / ,F Telephone: 03
2 . Owner of Property: /'DO4&
Address: Telephone:
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# ,5 -� Parcel#/g/, ,
Zoning District(s) (inclu overlays)
Street Address
Required
5 . EXiStina 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: 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) *C1 V0XJ'4A4eiAv1T , i/io.�.j u�a.L/�i:✓s f S1� ��,�
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: q11 Applicant's Signature: _,.a, 001L2.1
- - - - - - - - - - , .. . .,.
THIS SECTION FOR OFFICIAL USE ONLY:
n
` Approved as presented/based on information presented °
Denied as presented--Reason: � —1482 9 '
Special Permit and/or Site Plan Required:
Finding Required: Variance Required:
-z' -
Signature o ilding Inspector ` Date
1�
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 granting authorities.
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