25C-186 (6) PERMIT APPLICATION CHECK LIST
ES DATE
3 , OWNER
3 SETS OF PLANS /PLOT PLAN
NEW S
6 , CURB CUT
7 WATER
8 . REMODELING
9 , ADDITION
0 , ACCESSORY C
11 , SIGN / AWNING
2 , PERMIT FEE,&jdWW - MONEY npDERAiUMOM
13 . SPECIALRERMIT REQUIRED IF APP IC B
4 . UNDER S - CMR 780
5 , FORM A
6 , FILL
COMMENTS :
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Zoning OR t?—
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. —+;3 19 Additions
~, Repair
APPLICATION FOR PERMIT TO ALTER Garage
1. Location 11 F l"Y Lot No.
2. Owner's name Address M�
3. Builder's name .fir fH Addressaj Lt"Zjm f;e-)A" W27
Mass.Construction Supervisor's License No. tj j (�� + Expiration Date (; /
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
13. Siding house
14. Estimated cost- 'Vey
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
e
Signaru oj:resp nstbte appicane
Remarks
Date Filed File No.
ZONING PERMIT APPLICATION
I . Name of Appli ant: a,
Address: 1 ,�, { , Telephone: �
2 . owner of Property: ' ? , e14 vn-10
Address: ���� j�;j/ 1, r� 1� -�: l Telephone:
3 . Status of Applicant: Owner .Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet#
Parcel I8(o
ZoningDistrict(s) (include_ ov ys). r Wy
..e S tr eet Address
1
Required
5 • Exist�n Proposed by Zoning
Use of Structure/Property
(if project is only, interior w k, 4iP to #6)
Building height
°sB1dg. Coverage (Footprint)
Setbacks - front
- side L: R: L: R:
- rear
Lot size
Frontage.
Floor Area Ratio
oOpen 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)
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.
4
Date:. lv ,, Applicant's Signature:,
THIS SECTION FOR OFFICIAL USE ONLY:
YApproved as presented/based on information presented
Denied as_ presented--Reason:
S cial'&e ' nd/or Site Plan Required:
g Variance Required:
gnatu 'of Bu�.ldina In actor D e
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 Hoallh,Conservation commission, Dopartmont of Public Works and otlior appiicablo permit granting authoritios.
C ity of Northampton REQUIRED INSPECTIONS
b
BUILDINGDEPARTMENT 1. F ootings and Walls *2. Structural Components in Place
3. Complete Building*
No. 426 Office of the Building Inspector
Zoning Form No. 004324 Date 5/30/95 Fee $20 Check#582
Page, 25C Parcel 186 ,Zone URC Section 127 ❑ Yes Q No
BUI]LDINGPERINM
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT William Mazuch before Building Inspections
has permission to Replace front & rear doors Inspection on Site —Foundations
situated on 22 Highland Ave. Inspection of Plumbing—Rough
provided that the person accepting this permit shall in every respect Inspection of Plumbing—Finish
conform to the terms of the application on file in this office, and to the Gas Inspection
provisions of the Statutes and the Ordinances relating to the Construction, Inspection of Wiring—Rough
Maintenance and Inspection of Buildings in the City of Northampton.
Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring—Finish
of this permit.Expires six months from date of issuance,if not started. Building Inspection—Rough
Note:A certificate of occupancy will be issued by this office upon return Insulation Inspection
of this card signed by the Plumbing,Wiring and Building Inspectors.
** Install per Manufacturers information: windows, vinyl siding, Building Inspection—Finish
roofs and woodstoves. Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON rME P
Certificate of Occupancy
'` B ding Inspector