28-011 (3) nPERMIT APPLICATION CHECK LIST
PAGE Ott? PLOT !/ ZONE +�--eg YES NO DATE
ZONING FORM APPLICATION
2 . PERMIT I I
3 OW O
PLAN
5 . NEW CONSTRUCTION
6 . CURB OUT
7 WATER
8 . REMODELING
9 , ADDITIO
10 . ACCESSORY STRUCTURE
ii . SIGN
12 , PERMIT FEE - CHECK ONLY - MONEY DE
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
4 . UNDER SEC 7 - C R 780
15 FORM A
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
Garage
1. Location i� G^�iT�l /S�IJ Lot No.
2. Owner's name_ fa m t r Address
3. Builder's name ,n-.e Address s� z-
Mass.Construction Supervisor's License No. 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:-
z7-, The undersigned certifies that the above statements are true to the best of his, her
q�j knowledge and belief.
Signature of responsible app,icant
Remarks J AQ
Date F 0033?iled File No.
ZONING PERMIT APPLICATION
1 . Name of Applicant:
Address :._ _s;, v�Csn r_ 12J— Telephoner-- '-y---
2 . Owner of Property: . A02
Address: Telephone:
3 . Status of Applicant:
Owner Contract Purchaser
Lessee Other (explain )
4 . Parcel Identification: Zoning Map Sheet# � ` Parcel# /(
Zoning District(s) (include ov rlays),
Street Address ,
Required
5. Existing Proposed by Zonin
Use of Structure/Property r,
(if project is only interior work, skip to #6)
Building height
%Bldg. 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 necessar )_
Ali i S f c w% ,�G�+.-r
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: Applicant's Signature: ._
TH18 SECTION FOR OFFICIAL USE ONLY:
_L�Approved as presented/based on information presented
Denied as presented--Reason:
Sp 'al' Permit t�/or Site Plan Required:
i Requir .idj/ ,; Variance Required:
S nature uild'Ing Inspector D e
NOTE: Issuance of a zoning permit does not relieve an applicants 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 pormit granting authoritias.
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City of Northampton REQUIRED INSPECTIONS
BUILDING DEPARTMENT 1. Footings and Palls •
2. Structural Components in Place*
3. Complete Building*
No. 967 Office of the Building Inspector
Zoninja Form No. 003325 Date 9/22/94 Fee $40 Check# 287
Page,v 28 Parcel 11 ,Zone RR Section 127 ❑ Yes ® No
BUI]LDINGPERMI rr'I
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Michael Samson before Building Inspections
has permission to Finish 2nd floor Inspection on Site—Foundations
situated on 284 Sylvester Road 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.
Building Inspection—Finish
Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPI"U , N THE PREMISES
Certificate of Occupancy -
Building-I spector
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