17C-047 (2) PERMIT APPLICATION CHECK LIST
PAGE Z(" PLOT 47 ZONE U)t-�U YES NO DATE
ZONING FORM APPLTCATION
PERMIT APPLICATION C'
3 OWNER OCCUPANT STAT EMENT Z LICJ IF NOT
3 SETS OF PLANS /PLOT PLAN
NEW CONSTRUCTION
6 CURB CUT
T. WATER AVAILABILITY FORMS
8 , REMODELING INTERIOR
9 . ADDITION
0 , ACCESSORY STRUCTURE
SIGN Z AWNING
12 , PERMIT FEE CHEQK ONLY - MONEY ORDE
3 , SPECIAL PERMIT REQUIRED WITH DEED IF APPI.ICABLE
4 . UNDER - CMR 780
5 FORM A
6 . FILL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. i Alterations
NORTHAMPTON, MASS. rCJ 19 Additions
1
APPLICATI FOR PERMIT TO ALTER Repair
Garage
1. Location Lot No.
2. Owners name Address__
3. Builder's name Address
Mass.Construction Supervisor's License No. eze g,9� --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:-
The undersigned certifies that the above state nts are true to the best of his, her
knowledge and .
d of responsible app�ican!
Remarks �etit a�
1 �
Date Filed v 0300 `} File No.
O NG P T AP I ION (§10 2)
I. Na e f Ap is
Ad Tess : _ f elephone:
2 . Owner of Propert
Address : ��� Telephone: _ a
3 . Status of Applicant: owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# Parcel#q,
Zoning District(s) (include ov rl s)
Street Address
Required
5. Existinq Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
tB1dg. Coverage (Footprint)
Setbacks - front
- side L: R: L: R:
- rear
Lot size
Frontage
Floor Area Ratio
tOpen Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6 . Narrative Description of P opo d Work/Proje ( additi nal shee
if necessary)
't
7 . Attached Plans: Sketch Plan Site Plan
8 . Certification: I hereby certify that the information- a i n e d r
is true aTd a curate to the best of my knowledg .
Date: Applicant's Signature: ,
� ,/ THIS SEC TION F
FOR OFICIAL USE ONLY:
`approved as presented/based on information presented
Denied as presented--Reason:
Special'* Permit and/or Site Plan Required:
F' d ' g Re f Variance Required:
gna.tu of Builds ector JA NOTE: Issuance of a zonin
g 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 permit granting authorities.
City of Northampton REQUIRED INSPECTIONS
DEPARTMENT 1. Footings and Walls
BUILDING 2. Structural Components in Place*
3. Complete Building*
No. 689 Office of the Building Inspector
Zoning Form No. 003003 Date 7/20/94 Fee $20 Check# 4974
Page, 17C Parcel 47 ,Zone URA Section 127 L) Yes 0 No
BUI]LDINGPERMII-I
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Bob Thibodo before Building Inspections
has permission to Install 1 ply rubber to rear dormer & flashing work Inspection on Site—Foundations
situated on 81 Fox Farms Road Inspection of Plumbing—Rough
provided that the person accepting this permit shall in every respect Inspection of Plumbing—Finish
confonn 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 CONSPICU S P ACE PREMISES
C rtificate of Occupancy --
Building Ins r�_