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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. L -0,3gz Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO LTER Repair
a
Garage
1. Location 57 E E E Lot No.
2. Owners name a ,A'dddr ss
3. Builder's name
Mass.Construction Supervisor's License No., G 5 Expiration Date
4. Addition
5. Alteration
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 cosic
The undersigned certifies above stAtern are true to the best of his, her
knowledge and be
G
Signature of responsible app,icane
Remarks
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10. Do any signs',eAst on the property? YES NO
IF YES, describe size,type and location:
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I
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 DOE TO
LACK OF INFORMATION.
This col- to be filled in
by the Bnilding Department
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 kno e .
DATE. APPLICANT's SIGR!ATURE o
NOTE: Issuance of a zoning permit does not reilieve an IicanYs burden to comply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
I leg x�.
L{ 7 [
File No.
s
ZONING PERMIT APPLICATION
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: leph ne: G 1�
2. Owner of Property: 2
Address: ! ;�����elephone:—Q�O `
3. Status of Applicant: Owner Contract Purchaser _Lessee
Other(explain):
4. Street Address:
Parcel Id: Zoning Map# ` Parcel# ,,5 District(s):
(TO 135 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):
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 PermitiVariance/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 if
f)
I
APPLICANT/CONTACT PERSON:
ADDRESS/PHONE: C't� C Z C�c��L- � C �� I
PROPERTY LOCATION:
MAP 1!Z PARCEL: /.5 ZONE L/!/CA
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Fee Pnid
Iguilding Permit Filled nut
✓ 6 C s
(��� ✓
TI EF- LLOWING 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 Con rvation Co Sion
/O Z
Signature oTBuAding hwedtKr l5ate
NOTE:lssumnoe of a zoning permit does not relieve an appiloants burden to oomply with all
zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commisalon, Department of Publio Works and other applicable permit granting authorities.
�0Q� gof
City of Northampton REQUIRED INSPECTIONS
e 1. Footings and Walls
BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
No. 922 Office of the Building Inspector
Zoning Form No. 960379 Date10/24/95 Fee $20 Check#5226
Page, 17C Parcel 315 ,Zone URB Section 127 ❑ Yes 0 No
BUI]LDINGPERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Rober Thibodo before Building Inspections
has permission to re-roof house & 1 ply rubbon on porches. Inspection on Site—Foundations
situated on 19 Lake St. - Mary DePaola Inspection of Plumbing—Rough
provided that the person accepting this permit shall in every respect Inspection of Plumbing—Finish
conform to the terms of the application on file in this office, and to the Gas Inspection
provisions of the Statutes and the Ordinances relating to the Construction, Inspection of Wiring—Rough
Maintenance and Inspection of Buildings in the City of Northampton.
Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring—Finish
of this permit.Expires six months from date of issuance,if not started. Building Inspection—Rough
Note:A certificate of occupancy will be issued by this office upon return Insulation Inspection
of this card signed by the Plumbing,Wiring and Building Inspectors.
Building Inspection—Finish
** Install per Manufacturer's information: windows,vinyl siding,roofs Smoke Detectors (Fire Department)
and woodstoves
Other
THIS CARD MUST BE DISPLAYED IN A CON$PJCIJOUS LA ON T ES
Certificate of Occupancy l/
Building Inspector