17C-221 (3) PERMIT APPLICATION CHECK LIST
PAGE '7 C PLOT aZ ZONE C N "10- YES NO DATE
1 . ZONING FORM APPLICATION
2 . PERMIT APPLICATIONL'
3 . OWNER OCCUPANT STATEMENT LIC . #-- IF NOT
4 . 3 SETS OF PLANS PLOT PL Ne(c
5 . NEW CONSTRUCTION
6 . CURB CUT
7 . WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 . ADDITIO
10 . ACCESSORY- STRUCTURE
11 . SIGN / AWNI
12 . PERMIT FE - CHECK ONLY - MONEY ORDER
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 . FORM A
16 . FILL
COMMENTS :
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l 'gQ°jC Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. ='� '-i �!�✓ Alterations
NORTHAMPTON, MASS. '°�"-7 19R 3 Additions
Repair
go APPLICATION FOR PERMIT TO ALTER
Garage
1. Location ` ; Lot No.
2. Owner's name i M Address " MPtP(-C–'—,
3. Builder's name Address E",
Mass.Construction Supervisor's License No. r6r\ % 1 Expiration Date
4. Addition
5. Alteration t 1
6. New Porch K3
7. Is existing building to be demolished? IDZ7
8. Repair after the fire II,^� �//`�
9. Garage l� ltffi No.of cars Size
10. Method of heating Q cs V-<-5�
11. Distance to lot lines -- ``
12. Type of roof , T
13. Siding house
14. Estimated cost A- --; C c)o,
The undersigne c Ties ve tements pre e best of his, her
knowledge an
Signature of respon ,;cant
Remarks
adi�rn. l
Date Filed 4 -7 - q_3 v 00083 -1 File No-. 1-7 C- a� 1
ZONING PERMIT APPLICATION (§10. 2) C B
1. Name of Applicant: (:I p
Address: �� � � - Telephone:
2 . Owner of Property:
Address: M�,pt� �-�-, F 0 'l:. NDCGC-_ Telephone:
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# 1,7c Parcel# a-z I ,
Zoning District(s) (include overlays) C J__?
Street Address 5 S-
Required
5 . Existing Proposed -by Zoning
Use of Structure/Property P, N---r
(if project is only interior work, skip to #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
if necessary) ►;,� ,� ; -r
f— .1�`1►�Y% �t� N( f� ��1A� CAD A Li_ 0�6!-�
7 . Attached Plans : Sketch Plan Site Plan
8 . Certification: I hereby certify that the information ai ed herein
is true and accurate to the best of my knowle I
Date: Applicant's Signature: i7 n
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
THIS SECTION FOR OFFICIAL USE ONL
' APR 7
Approved as presented/based on information present ;
Denied as presented--Reason: -
Special Permit and/or Site Plan Required:
F 'ndin e fired: Variance Require
`� 7
Z�77>
igna e of Bu ' ng Inspector a
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.
e,7. -
A o O2 yfl
City of Northampton REQUIRED INSPECTIONS
BUILDING DEPARTMENT �. Footings and Walls
2. Structural Components in Place*
3. Complete Building*
No. 175 Office of the Building Inspector
Zoning Form No. 000837 Date 4/7/9 3 Fee $40 neck# 149
Page, 17 C Parcel 2 21,Zone (A Section 127 ❑ Yes ® No
BUI]LDINGPERM] l
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Cary Clark before Building Inspections
has permission to Miscellaneous interior repairs & renovations Inspection on Site—Foundations
situated on 5 North Maple 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 S P ON TTY PREMISES
Certificate of Occupancy
g Inspector � �