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DEPARTMENT OF BUILDING INSPECTIONS ?
212 Main Street ' Municipal Building °°�M 5 •y��
INSPECTOR Northampton, Mass. 01060
AS A HOMEOWNER I UNDERSTAND THAT I MAY APPLY FOR AND RECEIVE
A BUILDING PERMIT FOR A HOME OR ADDITION I INTEND TO LIVE IN.
I ALSO UNDERSTAND THAT I AM RESPONSIBLE FOR KNOWING THE STATE
BUILDING CODE AND ZONING ORDINANCE OF THE CITY OF NORTHAMPTON.
BEING A HOMEOWNER AND NOT A PROFESSIONAL CONTRACTOR IN NO WAY
ABSOLVES ME OF ANY RESPONSIBILITY TO INSURE THAT ALL FACETS
OF THE RULES AND REGULATIONS ARE COMPLIED WITH.
Signature & Date
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
a NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location /Y V P-1019CiA4k- V-'A A)0r fh 4,1 p k)-y 1114 Lot No.
2. Owners name Chr,S+o phe'i- -Al, t4j44 11 VQ Address /"// ktelrr k. P-.C?j
3. Builder's name :S t:!'3 C_ Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration Coti V6 1'`- Gh re7Q C +0 L►cil�u� l�n^� �ne')
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 1 14o /i)t-
11. Distance to lot lines ,1,60 ,
12. Type of roof 1, t tyq
13. Siding house
14. Estimatedcost:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge-and belief.
f
Signature of responsible Wplicant
Remarks
PNINT±SHOP
~ Data P'iled / yr V File. No
Z014ING PEILHIT APPLICATION (910 , 2 )
i
1 . Name •of Applicant : Cti*05�' t-CV
Address I /-IV lzle't- 2' Tel -phone i 7 ?
2 owner of Property :
Address : Telephone ;
owner Contract PurehAsep l
• • 3 �.1. . ,Status 'oi' Applicant :./ .. .
Lessee Other (eXplaT—n : ._._
—�
4 . Parcel Identification t zoning Map Sheet# Paroe l;/, ,
zoning Di,str ict (s) (inclu"- .overlays) r✓ ..._._
SCI;eet Address
liogY jirod ,
5 . Gxistincr nLOpoaed 1?Y.lt.S?i1. ncr
Use of. Structure/Property
(i,f• project 'is only intovior 1YOxk, s— kip to G
B%ai-IcliiIq height '
kpicig , coverage (Footpriti t)
S,ethackS - front
- sidd
- rear
LOI; size _....
ploor, Area Ratio
kapoll Space (Lot area 'nl.lnus
and park.inq) _....._._.
PA'r};iI1cJ •Space,s _..._
Signs
F'iIA (Volwlnle & locataoll) ,
6 ; Narrn't:ive Description, qf Proposed Work/Prof, ot; (Use additiorm�..xslleets
��
h rev-tit
? � � ' Attactied Planst Sketch Klan
Site P1'an
S ,' : Certification : ,Thereby certify that the information oontuinscl herein
i,'s true and accurate to the best of my knowledge ,
Da J1 Applicant I•s Signature :
.., ..' �• _ — -"+ I Y — T _ .
UD OL!Hxe BACTION 'OZ O ''xCxAL J
. .
Apyrova-d as 'iaroseritod/based on inforinatIon' presented
Denied as presented .
Reasorll-for Deii ia'1 J
s, qua tire, of Bu lding Inspe.ctor .pate `"—
NOTE: laauanoo of a zonino•parmit dodo not rolluvo an applioonl'a burdun to cotnpy will! all zo►linp roduiromontn and of Wjl all+'�gulled paanhs
from tho Board.o(Monith, ConoorvatJon Cornmloalon, Popn+tmont of publlo.Worko and otiior oppllcablo ponnll oraitinp aLMcultiun,,•.•
if�y � . , ' . ' , '• ,
PERMIT APPLI CAT19 N CHECK LIST age & `f
Address py� ,� ,ti/�� f � C
Yes_ -,No Date
1 . Zoning Form Application i
2, Permit Application
3. Homeowner statement if a licable Li . H if not
4, 2 sets of plans -- GAA- u
5, Curb cut
6 Water Department, mpmn _
7, Permit fee - check only
�. Special Pedit required with deed
9. Under section 127 - CMR 780
Form A