38B-006 (54) City of Northampton
Massachusetts •
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building �5gl
Northampton, MA 01060
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Gas TENT PERMIT APPLICATION
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Plumbing� p106� 1
ElectriNorlru r,�,r,"�A (For Tents over 120 square feet)
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Permit Fee: $25.00 Check
PLEASE TYPE OR PRINT ALL INFORMATION f
1. Name of Applicant: Ismillk Co
Address: 12C �j �.�r�a� Telephone:_ q f3� �iq -Zgfg
2. Owner of Property: th i A C. ltt'sL
Address: Telephone:
3. Status of Applicant: Owner Contractor
4. Tent Location Address): 33 Elm 3}rac-1 Alum rnae koL-4 z Fromm
�1 euhla� 14 ' Zly;s)f�1►;,.� Teaks
5. Use of Property: Residential: Commercial:
6. Description of Tent:
Size: 1-20""3 a 0 c..XA ( 20 ,A 20 Nc f Can�«le!
Occupant Capacity: t,
Dates of Use: 3-15-ZON -4- 5 -Zp -20/L/
i,rre 14,r, tA.,-j K 20i1{ rnorniw9
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: 12' 2014 APPLICANT'S SIGNATURE
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._