17A-228 (4) PERMIT APPLICATION CHECK LIST
PAGE PLOT ZONE Lc.Q� YES NO DATE
1 , ZONING FORM APPLICATION
2 . PERMIT APPLICATION
3 . OWNER OCCUPANT STATEMENT ei`Co-�F NOT
3 SETS OF PLANS /PLOT PLAN
5 . NEW CONSTRUCTION
6 , CURB CU
7 . WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 . ADDITION
10 , ACCESSORY ST UC U E
11 . SIGN / AWNING
2 , PERMIT FE - 0 L - MONEY ORDER 17 J
13 , SPECIAL PERMI UIRED WITH DEED IF APPLICABLE
,14 , UNDER S -CTION 127 - CMR 780
15 . FORM A
16 . FILL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
/��
NORTHAMPTON, MASS. l IAA'\/\Q 19q Additions
ti
Repair
APPLICATION FOR PERMIT TO ALTER
Garage
1. Location , <- / e—
_ a :2 Lot No.
2. Owner's name jfk�t o ld D0 ij a;-� Address I o�— �A o
3. Builder s name -"X 5.k t v= Address !�,.,i in S F
Mass.Construction Supervisor's License No. [L 6 2 _Expiration Date��—S y
4. Addition
5. Alteration Ak-W A,r,r
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:- ?aU
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Aao 43"
3vl Signature of responsible app,icant
Remarks
Date Filed //t `
�v l° � � File No.
ZONING PERMIT APPLICATION (510 . 2 )
I . Name of Applicant: V
Address :— -Telephone :
2 . Owner of Proper.ty:_Rick(d Bp r,�,�
Address :_ /oS Telephone :
3 . Status of Applicant- Owner Contract Purchaser
Lessee Other (explain ; ��1 �;✓cam_ )
4 . Parcel Identification: Zoning Map Sheet# c/11� arcel# ZZg,
Zoning District (s) (include overl y ) G(,
Street Address Ws_
Requ red
5 . Existing Proposed by Zoning
Use of Structure/Property
(if project is only interior work, kit o #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 Proposed Work/Project: (Use additional sheets
4
if necessary) 4e [2,r �an-�
7 . Attached Plans : Sketch Plan Site Plan
8 . Certification : I hereby certify that the information contained herein
is true and accurate to the best of my knowledge .
Date : ���-�� Applicant ' s Signature :,,,iJ�t* A���,
THIS SECTION FOR OFFICIAL USE ONLY: r
,/'Approved as presented/based on information presented
Denied as'presented--Reason :
Special' P-prmit and/or Site Plan Required :
Finding; tequired: _ Variance Required :
q
gna u-te of Bui,lding Inspector J a e
NOTE: issuance of a zoning permit does not relieve an appiicont's burden to comply with all zoning requirements and obtain all required permits
from the Board of Health, Conservation Commission, Department of Public Works end other applicable permit granting nuthorillos.
10,71_
��°vg�I t-,lty UI n o ti1d1I11jJton REQUIRED INSPECTIONS
BUILDING DEPARTMENT 2. S��tt�l and Walls
Components in Place*
3. Complete Building*
No. 399 Office of the Building Inspector
Zoning Form No. 001188 Date-6/2/93 Fee 2S� 0 Check# 1737
Page, 17A Parcel 228 ,Zone URB Section 127 ❑ Yes Y No
BUI]LDINGPERMI rr I
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Scott Paquette/Richard Benoit before Building Inspections
has permission to Repair/re-roof house Inspection on Site—Foundations
situated on 105 Lake 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 WE ON THE PREMISES
Cr.rtificate of Occupancy _—
g Inspector
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