38B-006 (52) City of Northamp'cor,, 3g.6
Massachusetts t
i v { DEPARTMENT OF BUILDING INSPECTIONSfc "f
212 Main Street a Municipal Building
Northampton, MA 010GO 4
I ) BRAY 14 2014 TENT PERMIT APPLICATION
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Elecir',c F.,, "s` (For Tents over 120 square feet)
Permit Fee: $25.00 Check#
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: S r n Jk �i 1!?� R&Lv A j o oLet,?:o wj k,
Address: )2(y 1. ejj ``ST/-emit Telephone: (Y13)
2. Owner of Property: 3(h
Address: Telephone:
3. Status of Applicant: Owner Contractor
4. Tent Location Address): t�IeJ J�✓nc i h �����:�o �c; .
(TO�BE FILLED`tN B'1��THEvBUILyDIN�bEP_.AR�MEN"i)'
5. Use of Property: Residential: Commercial:
6. Description of Tent:
s a
Size: 1— 20 r +ems
Occupant Capacity:
Dates of Use:
1�rP� f" Y I�,Zesty 4 t'U,
7. ALL INFORMATION MUST BE COMPLETED: PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION.
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 N ��
NOTE: Issuance of a permit does not relieve an applicant's burden to comply with all zoning requirements
and obtain all required permits from the Conservation Commission, Department of Public Works and other
applicable permit granting authorities._