06-004 (3) 10. Do any signs exist on the property YES NO
L/
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 MAST BE COMPLETED, or PERMIT CAN BE DENIED DUB TO
LACX OF INFORMATION.
This col- to ba filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks -
I
- side L: R: L: R:
I
- rear
Building height
Bldg Square footage
%Open Space:
Lot area minus bldg
&paved parking)
#
of Parking Spaces
.r
# of Loading Docks
Fill:
:(vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
r,� is true and accurate to the best of my knowledge.
DATE: G�2 V/ v APPLICANT's SIGNATURE
NOTE: ls-suanOa of a zoning permit does not relieve a applioanra burden to oomply with al
zoning r"ulrements and obtain all required permits from tha Board of Health, Conservatic
iCommisslon, Department of Public), Works and other applloabla permit granting authorities.
FILE
LCT24 .
Fi 1 e No
T 1!'
ZONING PERMIT APPLICATION (§10 .
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: /1
Address:-S'K �J �OY'v N P,,h ' Telephone: �b �o�/r�
2. OwnerofProperty:� ���i/I✓ s��7/�C� l
Address: ->(r,;? 20 L-e e ej Telephone: l �O
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Street Address: 2-� J14`lli Pi✓'�L./ /�� � L/�'��/
Parcel Id: Zoning Map# Parcel# District(s):
CFO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property 1)2,/,V-
6. Description of Pro osed Use/Work/Project/Occupation: (Use additio a(sheets if necessary):
�d c` Ti(� G✓J i N�j �a��m G �./�/V � .'9✓V/0 li�r/��'s;9� -�...�
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 PermWahance/Finding ever been issued for/on the site?
NO DON'T KNOW
f�_ 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)
II �
T A
D
3 C rl
— � O
x Z ^` m
j Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.NoS��`�� Alterations jZ
NORTHAMPTON, MASS. �4'�`' y 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
if / Garage
1. Location >!l� �������-ew 11111-e., k�• l� � Lot No. ) �n
2. Owner's name A c�/J�'y ���Z4�_ Address,5'�-Z ��9 Y�12/V!J%�/ /7—� �✓ �!�`�
3. Builder's name J/h 1-2/5'W-5�6y.2 Address56_P74A?L��Cr /,)Of 0�
Mass.Construction Supervisor's License No. I"L �� � Expiration Date
4. Addition 1 j / > /�
5. Alteration lZ `�Jul?�i`L'i 'N(�t � G i�Al/V �_At /'10 Ll / /�'v4L l�'
6. New Porch
7. Is existing building to be demolished? _A/ 6
8. Repair after the fire
9. Garage / No.of cars Size VA -;t l�—
10. Method of heating .5`7"- P, YYI
1 l. Distance to lot lines
12. Type of roof
13. Siding house G�f'9
14. Estimated cos � d r 6/7>
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
Signature of responsible appicant
Remarks ri(� U �JL�.. ` "/'✓V U�i -e/!/
C/
FILE #
APPLICANT/CONTACT PERSON'
ADDRESS/PHONE:
PROPERTY LOCATION:
MAP PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLO D REQUIRED DATE
ZONING FORM MLED 01IT
Fee PRid
1111141ding Permit Filled ()lit.,o
�c
C) c
OLLOWING 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
Permit from Conservation C issio
r
o LS
Signature of Building a4c6or Date
NOTE:Issuance of to zoning permit does not relieve an appiioanYs burden to oomply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Pubiio Works and other applioable permit granting authorities.
City of Northampton REQUIRED INSPECTIONS
BUILDING DEPARTMENT 2. Strtruccttugral and Components in Place*
3. Complete Building*
No. 934 Office of the Building Inspector
Zoning Form No. 960393 Date 10/25/95 Fee 40 Check# 1279
Page, 06 parcel 004 Zone SR Section 127 ❑ Yes 0 No
BUI]LDINGPERM]l
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Jim Dawson before Building Inspections
has permission to remove plaster & sheetrock living room ceiling & bathroodtmspection on Site—Foundations
situated on 582 Haydenville Road - Leeds - Robin Stolk 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 i
Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICU US PL N THE PREMISES
Certificate of Occupancy
Burl
W1 1