17A-110 (5) a
� sy
O Z m
Z
x m c
r � c
A
' ) Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.�a`�'�z1 _ Alterations
NORTHAMPTON, MASS. 1-3 19, —i' Additions
s
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location �� /L 2 ��`� Lot No.
2. Owner's name Address
3. Builder's name 2dLi4��� �J�.1�/l Address
Mass.Construction Supervisor's License No. Expiration Date -�
4. Addition
5. Alteration // � i/.�C ri 1r�/�i/�'//��i�S 14 ti 4Z
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 statements are true to the best of his, her
knowledge and belief.
Sign tune of r ponsible app icant
Remarks
' 10. Do any signs exist on the property? YES NO
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES NO
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This colmaa to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - front
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
#,
of -Parking Spaces
of Loading Docks
Fill:
4vol-time--& location)
13 . Certification: I hereby certify that the information contained herein
�f. is true and accurate to the best of my knowledge.
DATE: APPLICANT's SIGNATURE
NOTE: Iss anoe of a zoning permit does not relieve an p loan s urd to comply with all
zoning requirements and obtain all required permits from the Board o ealth, Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
FILE #
*f Y t P.ate 9g i
Fi 1 e No.
ZONING PERMIT APPLICATION
PLEASE TYPE OR PRINT ALL INFORMATION /
1. Name of Applicant: ���/�
Address: 1/ �,�Teleph n�
2. Owner of Property
Address: ('�V 4�1-ele� Telephone:
3. Status of Applicant: Owner _ Contract Purchaser Lessee
Other(explain):
4. Street Address:
Parcel Id: Zoning Map# Parcel# District(s): /A a
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed UseNl/ork/Project/Occupation: (Use additional sheets if necessary):
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW _ YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO__L�e _ DON'T KNOW YES
IF YES,has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained ,date issued:
(FORM CONTINUES ON OTHER SIDE)
FILE 114 5 7
APPLICANT/CONTACT PERSON:�/1 t.� �° �JI.GC� c7 L rf�'2 s? 1,/ '
ADDRESS/PHONE: �'J`= G�/ c ee
PROPERTY LO ATION: c
MAP 12 , PARCEL: ,//�1, _ ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PER UT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONINC-FORM FIT LED OITT
Fee pnod
lRyi4ldiny,Permit Filled nut
V
a :t C� c�
THEOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
Approved as presented/based on information presented
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under:§ w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
I/
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval-Bd of Health Well Water Potability-Bd Health
Permit from Conservation miss' n
Signature of Building h4ector Date
NOTE:lssuanoe of a zoning permit does not relieve an applioants burden to oompty with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioabie permit granting authorities. —
City of Northampton REQUIRED INSPECTIONS
$
I. Footings and Walls
BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
No. 997 Office of the Building Inspector
Zoning Form No. 960457 Date 11/13/95Fee $20 Check# 1141
Page, 17A Parcel 110 Zone URA Section 127 ❑ Yes ®No
BUJILDINGPERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THATHome Construction Remodeling/Donald Groleau before Building Inspections
has permission to install 11 replacement windows & vinyl siding. Inspection on Site—Foundations
situated on 21 Claire Avenue - Philip Costello Inspection of Plumbing—Rough
provided that the person accepting this permit shall in every respect Inspection of Plumbing—Finish
conform to the terms of the application on file in this office, and to the Gas Inspection
provisions of the Statutes and the Ordinances relating to the Construction, Inspection of Wiring—Rough
Maintenance and Inspection of Buildings in the City of Northampton.
Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring—Finish
of this permit.Expires six months from date of issuance,if not started. Building Inspection—Rough
Note:A certificate of occupancy will be issued by this office upon return Insulation Inspection
of this card signed by the Plumbing,Wiring and Building Inspectors.
Building Inspection--Finish
** Install per Manufacturer's information: windows,vinyl siding,roofs Smoke Detectors (Fire Department)
and woodstoves
Other
THIS CARD MUST BE DISPLAYED IN A CON$PJC US PL E N THE PREMISES
Certificate of Occupancy