17A-139 (4) PERMIT APPLICATION CHECK LIST
PAGE /Z/2 PLOT /j / ZONE ' 'Syr �' ' r ' =%2G YES NO DATE
1 . ZONING FORM APPLICATION '
2 . PERMIT APPLICATION
3 . OWNER OCCUPANT STATEMENT LIC. # IF NOT
4 . 3 SETS OF PLANS T PLAN
5 . NEW CONSTRUCTION
6 . CURB CU
7 . WATER VAI B T FORMS
8 . REMODELING INTERIOR
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 . SIGN / AWNING
12 . PERMIT FE d NLY - MONEY ORDER
13 . SPECIAL PERMIT REQUIRED WITH DEED IF 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. f;ZRZ;�?Z/ Alterations
a NORTHAMPTON, MAS . 19 Additions
APPLICATIO F R PERMIT TO ALTER Repair
� Garage
1. Location t No
2. Owners name Address__
3. Builder's name -f— ddres
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 4 �✓
12. Type of roof ism�✓
13. Siding house
14. Estimated cost:-
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The undersigns i ies at the above statemc are e to the best of his, her
knowledge d belie
r„q Signature ojresponsible app i.cant
Remarks W
4sRyn.
H
Date Filed 73 001540 File No.
ZONING PE T APP O ( 10 . 2)
1. Name of Applicant:
Address : G le hone: --G -
2 . Owner of Property:
Address : Telephone:
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# 1-74 Parcel# /,'y ,
Zoning District(s) (include overla s)
Street Address / ,.uL _
Required
5. Existinq, P o osed 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
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 necessary)
7 . Attached Plans : Sketch Plan Site Plan
8 . Certificati I hereby certify that the information contained herei
is tru�i � curate to the best of my knowledg
Date: Applicant's Signature •
THIS SECTION FOR OFFICIAL USE ONLY:
Ap oved as presented/based on information presented
Denied as presented--Reason:
Special' Permit and/or Site Plan Required :
F ' di Require Variance Required:
S nature f Ming I e
NOTE: Issuance of a zoning perm oes not relieve an applicant's burden to comply whii all zoning roquirements and obtain all required permits
from the Board of Hoalth, Consarvation commission, Departmont of Public Works and other applicablo permit granting authorities,
City of Northampton REQUIRED INSPECTIONS
• 1. Footings and Walls
e BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
No.
698 Office of the Building Inspector
Zoning Form No. 001546 Date 8/9/93 Fee $20 Check# 3654
Page, 17A Parcel 139 ,Zone URA
Section 127 ❑ Yes No
BUI]LDING PERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Bob Thibodo before Building Inspections
has permission to Re-cover roof with asphalt shingles Inspection on Site—Foundations
situated on 221 chestnut 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 CONSPIC _ U PL ON THE PREMISES
Certificate of Occupancy -
- ng Inspector f