17A-067 (4) PERMIT APPLICATION CHECK LIST
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" E PLOT '° ► � ZONE `� � YES NO DATE
1 . APPLICATION
2
3 . OWNER OCCUPANT E NO
4 . 3 SETS OF S /PLOI PLAN
5 . NEW CONSTRUCTION
6 . CURB CUT
7 . WATER V S
8 . REMODELING INTERIOR
9 . ADDITION
10 , ACCESSORY STRUCTURE
11 . SIGN AWNING
12 . PERMIT FEE - 0 - MONEY 0 D
13 . SPECIAL PERMIT REQUIRED WITH EED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 , FORM
16 , FILL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
a NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Re p air
p� Garage
1. Location / Lot No.
2. Owner's name
3. Builder's name Address G
Mass.Construction Supervisor's License No. _Expiration Date
4. Addition Z<Z
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 certif at the above state n re ue to the best of his, her
knowledge and b ef.
\ ,
Signature of responsible ican!
Remarks
U
001P.,
Date Filed / x
File No,
ZONING PE IT A CATION (510 . 2)
1 . Name of Applicant: �' '
Address : Telephone:
2 . Owner of Property: �--c___.
Address : IV
6Telephone :
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification : Zoning Map Sheet# farcel# (,;,I ,
Zoning District (s) (include overlays) p
Street Address
Required
5 . Existing Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg. 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 Propos Work/Project : (Use additional sheets
if necessary)
7 . Attached Plans : Sketch Plan Site Plan
8 . Certification: I hereby certify that the information contained Zhin
is true and accurate to the best of my knowledge .
Date : Applicant's Signature : -
THIS SECTION FOR OFFICIAL USE ONLY:
Approved as presented/based on information presented
Denied as presented--Reason:
Special' Permit and/or Site Plan Required :
l nd ' g Re it Variance Required :
natu �of f uild ' -tor- at
NOTE: I a zoning permit does not relieve an applicant's burden t comply with all zoning requirements and obtain all required permits
from tho Board of Health, Conservation Commission, Department of Public Works and other applicable permit granting authorities.
it'T�-
City of Northampton REQUIRED INSPECTIONS
e BUILDING DEPARTMENT 2. Footings
tructural Components in Place*
� P
3. Complete Building*
No. 838 Office of the Building Inspector
Zoning Form No.
001734 Date 9/15/93 Fee $20 Check# 3630
Page, 17A Parcel 67 ,Zone ' Section 127 ❑ Yes ® No
BUI]LDING PERNM
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Bob Thibodo before Building Inspections
has permission to Re-shingle roof Inspection on Site—Foundations
situated on 22 Mountain street 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 CONSP U S LAC O THE PREMISES
Certificate of Occupancy
g Inspector f^