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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. ST LJ-S 777 Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
ti r
Garage
1. Location �� C���P �oy? �cE Lot No.
2. Owner's name Address 116 'r-
3. Builder's name 2cL r-0 y Address �Jtf'�
Mass.Construction Supervisor's License No. G S O(o Expiration Date &b.5110 7
4. Addition
5. Alteration z -vv6- S 'fit W 2 �s
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- 1006
The undersigned certifies that the above statements are true to the best of his, her
knowle belief.
ignature of responsible 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 aolm= to be filled in
by the Baildfng yeparbaent
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- 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:
. (volume & location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: �L?5_ APPLICANT's SIGNATURE C ¢ti-----
NOTE: lnuuanoe of a zoning permit does not relieve an applioan s burden to comply with all
zoning requirements and obtain all required permits from the B and of Health. Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
* � S
File No
r
ZONING PERMIT APPLICATION (§1
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 2x�'�
Address: 2 c-co -D Telephone: EXK—S 7 7
2. Owner of Property: v ,&
Address: l Telephone: �Z�'y
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Street Address:
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
�Je t2
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/Vadance/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 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 #
APPLICANT/CONTACT PERSO 1
ADDRESS/PHONE:
PROPERTY LOCATION: / /mil --2 `
MAP___L21 PARCEL: 4 ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLO ED REQUIRED DATE
Fee Pnoti
Fee Paid -
Rpmndpli
C/
c
TpkPOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
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
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
ermit f P em?o s ation Commission
Si afore of g Inspec or ate
NOTE: Issuance of a zoning permit does not relieve an applioant'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 other applioable permit granting authorities.
o�� go City of Northampton REQUIRED INSPECTIONS
1. Footings and Walls
BUILDING DEPARTMENT
B � 2. Structural Components in Place*
e
3. Complete Building*
No. 755 Office of the Building Inspector
Date 9/6/95 Fee $40 (Check# 1013
Zoning Form No. 960194
Page, 17A Parcel 210 ,Zone URC Section 127 ❑ Yes ® No
BUH.jDINGPERWI
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Barry Elbaum before Building Inspections
has permission to replace sheetrock in 12 X 15 room. Inspection on Site—Foundations
situated on 116 North Maple St. - Dorothy Hurley Inspection of Plumbing—Rough
P rovided that the Pe rson accepting this F''miit 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 not(d is an immediate revocation Inspection of Wiring—Finish
of this permit.Expires six months from dale 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 (7K
Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISP AYE A ONSPIC LACE PREMISES
Certificate of Occupancy _
Building lmxtror
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