12C-084 (3) PERMIT APPLICATION CHECK LIST
PAG ES NO DATE
1 .
2 .
3 . OWNER OCCUPANT STATEMENT NOT
4 . 3 SETS OF PLANS OT PLAN
5 . NEW CONSTRUCTION
6 . CURB CU
7 . WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 . ADDITION
10 . ACCESSORY STRUCTURE /
11 . SIGN / AWNI
12 . PERMIT FE - CHECK ONLY Aim
13 . SPECIAL PERMIT REQUIRED ITH DEE TF APPLICABLE
14 . UNDER SECTION 127- CMR 780
15 . FORM A
16 . FILL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Z 775 Alterations
NORTHAMPTON, MASS. �/ 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
a
Garage
1. Location Lot No.
2. Owner's name /��,�.,,.�_: � — � � Address
3. Builder's name r Address
Mass.Construction Supervisor's License No. 62 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:- /ate.W
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
u
Signature of responsible app icant
Remarks
• wiVr�
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'= 003259
Date Filed File No.
ZONING PERMIT APPLICATION (§10. 2)
Name of Applicant:
1 : /
Address: ,� Telephone:
02 . .
owner of Property:
Address : .I Telephone:
3 . Status of Applicant: Winer Contract Purchaser
Lessee Other (explain: )
4 . Parcel. Identification: Zoning Map Sheet#`, Parcel#,
Zoning District(s) (include verlays)
Street Address
Required
5. Exis in Pro nosed bv Zon'
Use of Structure/Property
(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
%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)
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 knowl dge.
Date: Applicant's Signature ?
THIS C
SETI F
ON FOR OFICIAL USE O Yt r
`Approved as presented/based on information presented
Denied as presented--Reason:
S ecial' Permit and/or Site Plan Required:
n g Re red: Variance Required:
gna o Bua nspector Date
NOTE: Issuance of a zoning pormit does not relieve an applicant's burden to comply With all zoning requirements and obtain all required permits
from the Board of Hoolth,Conservation commission, Department of Public Works and other applicable permit granting aulhoritlos.
/e v_
City of Northampton REQUIRED INSPECTIONS
g a 1. Footings and Walls
e BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
No. sao
Office of the Building Inspector
Zoning Form No. 003259 Date 9/2/94 Fee $20 Check# Money order
Page, 12C parcel 84 ,Zone URA Section 127 ❑ Yes ® No
BUIULDING PERTUTI
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Wayne Brown before Building Inspections
has permission to Strip & reshingle roof Inspection on Site—Foundations
situated on 44 Mary Jane Lane Inspection of Plumbing—Rough
provided that the person accepting this pen-nit 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
** Install per Manufacturers information: windows, vinyl siding,
roofs and woodstoves. Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUO P CE ,N THE PREMISES
Certificate of Occupancy � --
Buildin for �_