05-058 (2) 'FAQ
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PERMIT APPLICATION CHECK LIST
PAGE t) PLOT 2ONE�W-'-11 R �� � �� �� YE NO DATE
1 . ZONING FORM APPLICATION
2 PERMIT P LICA ION
3 . OWNER OCCUPANT STATEMENT RLIC . #, IF NOT
4 . 3 SETS OF ANS /PLOT _ PLAN
5 NEW CONSTRUCTION
6 . CURB CUT
7 . WATER AVAILABILITY FORMS
a . REMODELING INTERIOR
9 ADDITIO
10 , ACCESSORY STRUCTURE
SIG N / AWNING -
12 , PERMI FEE - CHECK O LY - MONEY ORDER k4 C L-
13 , SPECIAL PERMI RE UIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 , FORM A
16 ,
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. /L _19
Additions
a APPLICATION OR PERMIT TO ALTER Repair
Garage
t �
1. Location �� w�c. �J ti-ter v� , C t� ,f' f"v � C I Cl�� Lot No. n
2. Owner's name .- Z- Address�j i r�-�
3. Builder's name /11 1 Address
Mass.Construction Supervisor's License No. Do Expiration Date (e 7
4. Addition
5. Alteration �N C Z_ k 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:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief. -�„
b1i 6e
Signature of responsible apparAt
Remarks
PHINyTTSH�OP
Date Filed r 0 0 O J J J File No.
ZONING PERMIT APPLICATION (§10. 2)
1. Name of Applicant: w
I 1
Address: V4 r Telephone: y,�2
2 . Owner of Property- -.– ,1
Address: I Telephone:
3 . Status of Applicant: Owner —Contra ct PiArchaser
Lessee Other (explain: c_
4 . Parcel Identification: Zoning Map Sheet# Parcel# J� ,
Zoning District (s) (include/!overlays);
Street Address _ I Ct.t trttzc,f `-�
Required
5. Existing Pro osed bv Zonin
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
- side L: L:
- rear
Lot size
Frontage
Floor Area Ratio r
oOpen Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs ` f
Fill (volume & location)
. 6 . Narrative Description of Proposed Work/Project: (Use additional sheets
if necessary)
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: /� to Ll . Applicant's Signature:
— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —
THIS .SECTION FOR OFFICIAL USE ONLY:
r/AAppproved as presented/based on information presented
Denied as presented--Reason:
Special Permit and/or Site Plan Required:
i equired: Variance Required:
2-
Bu 'Signa of Inspector D to
NOTE: Issuance of a zoning permit does not relieve an applicant'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 applicable permit granting authorities.
i e 7' _
City of Northampton REQUIRED INSPEC
, BUILDING DEPARTMENT 2. S�r�t�d Walls % . *
Componer_�. .,i Place
3. Complete Building*
No. 782 Office of the Building Inspector
12/16/92
Zoning Form No. _0 g Date__ Fee $40 . Check# 4295
Page, 5 Parcel 58 ,Zone RR
Section 127 ❑ Yes ❑ No
BUH.jDING
* Plumb_.rg and Electrical Inspections required
THIS CERTIFIES THAT Ira Helfand & Deborah s in i t h before Building Inspections
has permission to Finish Recreation Room in Basement Inspection :gin Site—Foundations
situated on 371 Audubon Rd. ? Leeds , MA 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,
Maintenance and Inspection of Buildings in the City of Northampton. Inspection of Wiring—Rough� '��� Z
Any violation of any of the terms above noted is an immediate revocation InspecCon of Wiring—Finish SI
of this permit.Expires six months from date of issuance,if not started. Buildir�;;Inspection—Rou
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.
Builduig Inspection—Finishes/6
Smoke Detecl.ors(Fire Department)
Other
THIS CARD T Bp DI';PLAYED IN A CONSPIC OUS PL (::,'E ON THE PREMISES
Certificate of Occupancy. _- I---i
g Inspector
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