25C-014 (3) PERMIT APPLICATION CHECK LIST
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PAGE � . � �� " YES NO ` DATE
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2 . AfigL=!IbW
3 . OWNER OCCUPANT E IF NO
4 . 3 SETS OF S PLAN
5 NEW CONSTRUCTION
6 . CURB CUT
7 WATER S
8 . REMODELTNG
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 . SIGN G
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12 . PERMIT FEE - C - MONEY 0
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 . FORM
16 . FILL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
' APPLICATION FOR PERMIT TO ALTER Repair
�r Garage
1. Location / Ga ail'/(�0� �Id V/�/ �1/d /� �� Lot No.
2. Owner's name Address 70 A/&W Ad 11111T /T 49 ,
3. Builder's name / Address
Mass.Construction Supervisor's License(No.) f 0-7/In�> Expiration Date
4. Addition
5. Alteration
6. New Porch L
7. Is existing building to be demolished? 75�
N.
8. Repair after the fire
9. Garage No.of cars Size
0. Method of heating
1. Distance to lot lines
2. Type of roof
3. Siding house
4. Estimated cost 0
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The undersigned certifies that the above statements are true to the best of his, her
\y knowledge and belief.'
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Signature of respons'Sle appicant
remarks
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1
Date Filed 2 371 3 File No.
ZONING PERMIT APPLICATION (510 . 2 )
1 . Name of Applicant:I/j/I /✓P J L/ / /.IqA
Address :_17 Z 1. �C1�S /3Tf_ (/Z Telephone:
2 . Owner of Property: G /Y9 � r )li& /*U
Address :- 20 122 ,,�41'1 / It —Telephone:
3 . Status of Applicant: - owner contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# )-4� L Parcel#_ 4
Zoning District (s) (include overlays) .
Street AddressG�
Required
5• Existinq Proposed by Zonin
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) p A,1 a 6, e- /TIC/& = R
G U
Y
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: 3 d G Applicant' s Signature: �i-C�� 7Z
THIS SECTION FOR OFFICIAL USE ONLY:
Approved as presented/based on information presented
Denied as presented--Reason:
Special' Permit and/or Site Plan Required:
44n?in quired: Variance Required:
e a of Bu ' nspector ( D e-
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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 ft Board of Health, conservation Commission, Departmont of Public Works and other applicable permit granting authorities.
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