05-060 (4) PERMIT APPLICATION CHECK LIST
PAGE PLOT � C�' ZONE ��� � YES NO DATE
1 . ZONING FORM APPLICATION 4C `7 A`_td t,b) o ri �'` to ,5-9 "a-
2 . PERMIT APPLICATION
3 . OWNER OCCUPANT STATEMENT LIC . # IF NOT
4 . 3 SETS OF PLANS PLOT PLAN
5 . NEW CONSTRUCTION
6 . CURB CUT
7 . WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 . ADDITION
10 , ACCESSORY STRUCTURE
11 SIGN / AWNING
e-k ff-- '4 .3 ct a.
12 . PERMI FEE - CHECK ONLY - MONEY ORDER 0 �P-o t--
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 . FORM A
16 . FILL
COMMENTS :
Qc�0� Tav S
ro DI"7-'A'lL"I'hif-.N 1' UL (i1..1J1i111 �. 'NSI'.i;CTINONS
1'2: . 1 'w, Sh:e('.it Nfullicip;Al i3oddill',
INSPECTOR I�rortillinrptan, N1uas. 01060
_701,1.0) FUEL n,IIRN'I.NG AP'`I_1ANC . & ?rkiiMN} YAPPLICATION PERMIT NUMBER
i�
l.o r a t i c,ry L�t�i� „�`t�Cc, �� �� � �_ -V---
ON"TtE?Y C7Y 1..@R 0 �1 /V � /l�__Y- -- - �_ t✓'7 �{�C�(% c �� ��L' S �>�5 'G i 1
(Nnifir!) (Mr,i.) i i ig Address) �� (TeIe. No. )
Call t:rac to ti°
(Nac,t` (Addrr ws) (Tele. No. )
RESIDENTIAL NON-RESIDENTIAL.
otle f.nmi.1 y Hrrric _ Business
Two oi' Hol"! Other
Numbe of 1'ni.t,; Sp12Ci.fy
C -:7 `L Stories -Dl BuI.ldinp,
Typr.. of App 1.1 ance S -Z C,V L-O LD -� rz 1;
Wood burning
Used Coal
Labeled � Combination
DatE-, of Purrhase Other
—
---7' � S p e:c i.f y
14oct��1 or Type
�22vvtowT CA-. kl( s�A (� �L1?1��
i } p�_�_ ---
Mhnufactllrer" t tS�C�il/al'(
Purchased From UAJKWW A)
(Name of Firm)
(Address)
Cost - Constructi.on & Appliance $ VWT (SF- �JCZV
Chimney (Z) New _ Metal Bestos
�
Existing � _. Interior- chimney
Separate Flue _— Exterior chimney
Other Appl f artcc att.achr,,d to Cl,w
._� Masonary Lined
Unl.i.nr_d
Notes & Data:
Signature of Appli
cant:/// C�' %c'4JG�'d _ _ 4�
l r
(Ad cire.,s)
Approved By:
Title: Date:
tw,r rT
Date Filed �O- `� - �) - File No. ��S O G0 ZONING PERMIT APPLICATION (§10 . 2) R P._ W; P/W P
1. Name of Applican o J-1q /c'
Address : :2 �t G Gr- orb-, R Lt -Telephone:
2 . Owner of Property: A vv
Address : -e- Telephone:
3 . Status of Applicant: Owner Contract Purchaser
Lessee O her (explain: )
4 . Parcel Identification: Zoning Map Sheet# a!5_ Parcel#fir
Zoning Districts) (inc d ov rl ys)
Street Address � ��
Required
5 . Ex ' stina Proposed bv Zoning
Use of Structure/Property
(if project is only interior 'work, skip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
- side 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
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 knowledg .
Date: ), I 5ij Applicant ' s Signature: _
^THIS SECTION FOR OFFICIAL USE ONLY: _.
Approved as presented/based on information presented ACT
D nied as presented
fo enial :
igna e of Bui Inspector Date
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 tho Board of Health, conservation Commission, Department of Public Works and other applicable permit granting authorities.
7/92 FXAS
City of Northampton REQUIRED INSPECTIONS
A A
e
BLILDING DEPARTMENT 2. Footings and Walls Components in Place*
3. Complete Building*
No. 644 Office of the Building Inspector
Zoning Form No. 000348 Date 10/9/92 Fee $20 Check#4392
Page, 5 Parcel 6 0 ,Zone R R/w ss p Section 127 ❑ Yes 0 No
' MIT
BLILDING PER
Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Alan Branch before Building Inspections
has permission to ' Inspection of two (2) existing wood burning stoves Inspection on Site—Foundations
situated on 407 Audubon Road 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 pen-nit.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)
��--q�-
THIS CARD MUST ICE DISPL YED IN A CONSPICUOUS 'LACE ON THE PREMISES
Certificate of Occupancy /Z'—�'
ng Inspector
rC_°P_l
1!0I Silk