25A-190 (30) {
PERMIT APP ICATION CHECK LIST
PAOF PLOT ZONE u-� ,�I �C�fL W—YES NO
ZONING J . ON �(
2. PERMIT APPLICATION
3 OWNER 0 QCUPAdl STATEMEUI L � r - NO
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4 . 3 SETS OF PLANS /PLOT Pl_AN
5 . NEW CONSTRUCTION
CURB CUT
7 , WA198 AVAILABILITY FORMS
L REMODELING INTERIOR
9 . ADDITI
0 URE
11 . s,iGN AwNru
2 . PERMIT FEE - CHEQK ONLY - O ORDER
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
h UNQ,ER SECTION - QMR 780
15 . FORM A
16 . FILL
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.02C-3 `20ae Alterations ��r
NORTHAMPTON, MASS. 19 Additions
• Repair
e
APPLICATION FOR PERMIT TO ALTER
�9 Garage
1. Location A C 'X. Lot No.
2. Owners name i Address v�xfi6l �n f�i x1
3. Builder's name Z1Z2k-h-,,%,h) �'R��JiJ t' l S Address /O a M
Mass.Construction Supervisor's License No. Expiration Date 01,13 2 3
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 roof J%i ���s�'
13. Siding house
14. Estimated cost:- 3 0. �
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
L � Signature of responsible app,ican!
Remarks
Date Filed �,T-`//�=Ii � File No,
ZONING PERMIT APPLICATION (510 , 2 )
I . Name of Applicant:
Address :�G >�� : �( �S� /� �i= �� ✓;� />���'% Telephone : ;,P - 122,R"
J
2 . Owner of Property: �
Address :- j��; ar -/ /, /� _ Telephone :
3 . Status of Applicant : Owner Contract Purchaser
Lessee Other (explain : )
4 . Parcel Identification : Zoning Map Sheet# Parcel#
Zoning District (s) (inclu e ov rlays1 t� -
Street Address j / -('� t�
,
Required
5 . Existina Pro osed bv Zonin
Use of Structure/Property -1 .4 �_w,_-
(if project is only interior work, skip to 6)
Building height
tB1dg. Coverage (Footprint)
Setbacks - front
- side L: R: 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/Project : (Use additional sheets
if necessary)
i
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 : Applicant ' s Signature : L
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
THIS SECTION FOR OFFICIAL USE ONLY:
Approved as presented/based on information presented
Denied as`presented--Reason :
Special' r it and/or Site Plan Required :
ng e red: _ Variance Required :
gnat e of Buildi - - or �'\ Date
NOTE: Issuance of a zoning permit does not relieve an applicnnl's burden to comply with all zoning requiromonts and obtain all required permits
from tho Board of Hoaith, Consorvation Commission, Dopattrnont of Public Works and othor npplicnblo pormit granting nulhoritios,
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