25C-124 (6) PERMIT APPLICATION CHECK LIST
6 O-V
Yes No Date
1 . Zoning Form Application v i
2. Permit Application
3,,--'HomeownBp,statement if applicablead � f not L--'
4. 2 sets of plans
5. ' Curb cut
6 Water Depaa rt men . mamn
7.. Permit fee - check only g V
8.
Special Permit required with deed if applicable
9. Under section 127 CMR
Form-
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building \
INSPECTOR Northampton, Mass. 01060 s �`
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
GO NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
y— Garage
1. Location Lot No.
2. Owners name Gt G 44-YX, Address
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. dfi
5. Alte ation
6. New Porch ��"ti
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
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
knowled gel and belief.
C/I Signature of responsible applicant
Remarks
PS P
Date Filed File No.
ZONING PERMIT APPLICATION (510.2)
1. Name of Applicant: ` 1�
Address: /, Telephone:
2 . Owner of Property: � wN f�-
Address: �^ Telephone:
3 . Status of Applicant:-/Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# Parcel# ,
Zoning District(s) (in c 1 de,.ove s) L{�?
Street Address At
c,� �
Required
5. Existina Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6) r�M
Building height
%B1dg.Coverage (Footprint)
Setbacks - front
- side
- rear
Lot size
Frontage
Floor Area Ratio
%Open Space (Lot area minus \
building and parking) �..
Parking Spaces
Loading '
Signs
Fill (volume & location
6. Narrative Descrip ,ion of P oposed Work/Projec : (Use additional sheets
if necessary)
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 knowle .
Date: Applicant Is Signatur . , ' �E /'�✓ 1
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
THIS SECTION FOR OFFICIAL USE ONLY:
Approved as presented/based on information presented
Denied as presented
'son f Denial..
ign , a of B ng Inspector ate
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 the Board of Health,Conservation commission,Department of Public Works and other applicable permit granting authorities.
C/
IQ .. : City of Northampton REQUIRED INSPECTIONS
1 . Footings and Walls
BUILDINGDEPARTMENT 2 . Structural Components in
�) Place
p 3. Complete Building
No. 204
Office of the Building Inspector .
1�
Date April 15, 1992 19
BUI DING P RMIT
THIS MAY CERTIFY THAT royse Grenon
Insp. on Site — Foundations
has permission to Change wir�dot; to samller one, misc. repairs Insp. of Plumbing — Rough
situated on 212 Bridge Street Insp. of Plumbing —Finish
provided that the person accepting this permit shall in every re- Insp. of Wiring — Rough
spect conform to the terms of the application on file in this office,
and to the provisions of the Statutes and the Ordinances relating Insp. of Wiring — Finish
to the Construction,Maintenance and Inspection of Buildings in Insp. of Health (Septic Tanks)
the City of Northampton. Any violation of any of the terms above
noted is an immediate revocation of this permit. Expires six Building Insp. --Rough
months from date of issuance, if not started.
Building Insp. — Finish
Note:A certificate of occupancy will be issued by this office upon
return of this card signed by the Plumbing,Wir'ng nd Building Smoke Detectors (Fire Dept.)
Inspectors. Gas Inspection
THIS CARD MUST BE DISPLAYE I A CON_SP US -A ON THE PREMISES
Certificate of Occupancy -
l � Build' Spector