11C-022 (5) a
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. R 0(, C Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
! Garage
1. Location 7 h e Ft°r'i1c�v1 P La-as s fVL4 , Lot No.
2. Owner's name (3-06pi 2 p UPS e-�� Address
3. Builder's name �' �.. Address S't J" ,,64V14
Mass.Construction Supervisor's License No. " 7 1()3 ef Expiration Date
4. Addition
5. Alteration �I
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
1 Siding house
14. stimated cosL—A
M0
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Avt,
Sig azure of respo le appicant
Remarks
PERMIT APPLICATION CHECK LIST
PAGE PLOT 2-7- ZONE U-U- -7 ES NO DATE
1 . ZONING I O
2 . PERMIT I
3 0
3 S
NEW CONSTRUCTION
6 .
CURB CUT
7 WATER
8 . REMODELTNG
9 . ADDITION
0 , ACCESSORY
t , SIGN / AWNING
2 PERMIT E - CHECK ONLY -
3 . SPECIAL U IF APPLIC B
4 . UNDER E - CMR 780
FORM A
6 . FILL _
COMMENTS :
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Date Filed File No.
ZONING PERMIT APPLICATION (51 0. 2)
Name of Applicant: Ct:��" i
Address:— Telephone: - _
02 . owner of Property: �� G � /
Address : Telephone:
Status -of Applicant: Owner t--.-Contract Purchaser
• Lessee Other (explain
4 . Parcel Identification: Zoning Map Sheet# PC Parcel# 22-,
Zoning District(s) (include verlays)
Street Address ,
UU Required
5 . Existing Proposed -by Zoning
Use of Structure/Property
(if project is only interior work/O s ip #6
B ilding height
%Bldg. Coverage (Footprint) J p
Setbacks - froon�E
- side L: �,� ' R: L: f R:
- rear
size
Frontage.
Floor Area Ratio
oOpen Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
60 Narrative Description of Proposed Work/Project: .(Use additional sheets
if necessary)
7. Attached Plans: Sketch Plan Site Plan
S . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
Date
'�(�[ '�� � Applicant's Signature:
THIS SECTION FOR OFFICIAL ! ONLY: rG-
A proved as presented/based on information presented
nied as presented--Reason:
S. it and/or Site Plan Required:
i l�
n "ing i d: Variance Required:
gna of Buil nspector t
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 oUier applicable permit granting aulhorillos.
fell-