17D-056 (4) PERMIT APPLICATION CHECK LIST
PA ZON YES NO DATE
MN
1 . I
3 . OWNER OCCUPANT STAT MENT IF NOT
4 . 3 SETS OF PLANS /PLOT PLAI
5 . NEW CONSTRUCTION
6 . CURB CU
7 . WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 . ADDITIO
10 . ACCESSORY STRUCTURE
11 . SIGN W I
12 . PERMIT FE - 111M NLY - 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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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19— Additions
APPLICATION FOR PERMIT TO ALTER Repair
a Garage
1. Location . 2,-n-et S Lot No.
2. Owner's name Address
V
A
3. Builder's name Address: -/J
Mass.Construction Supervisor's License No. I 9r� 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 3L1;4)A44W-
13. Siding house
14. EstimatedCOSL-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of respons�ble app icam
Remarks
. .rives
Date Filed File No.
ZONING PERMIT APPLICATION (Sib. 2)
1 . Name of Applicant:
Address : L fir' Telephone: Sty
2 . Owner of Property: -
Address : / Telephone:
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain: )
i71D
4 . Parcel Identification: Zoning Map Sheet# 0#0 Rarcelf ,
Zoning District(s) (inclu overlays)
Street Address
Required
5 •
ZExistingPro osed by Z nin
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
- side L: 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 Wo k/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: A p p 1 i c a n t r s Signature
ZApproved THIS SECTION FOR OF UE FICIAL S ONLY:as presented/based on information presented
Denied as presented--Reason:
Special' Permit and/or Site Plan Required:
nding Re •r d• Variance Required:
` ' A'
4cgrnatur/e' Buy or D e 1`7
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning roquiroments and obtain all required permits
from tho Board of Health, conservation commission, Dopattmont of Public Works and othor applicable pormh granting authorities.
iell_
g�°� � City of Northampton REQUIRED INSPECTIONS
e
BUILDING DEPARTMENT 1. Footings and Walls
2. Structural Components in Place*
3. Complete Building*
No. 851 Office of the Building Inspector
Zoning Form No. 002791 Date g/2A/q4 Fee 20 Check# 483
Page, 17D pal 56 ,Zone URB Section 127 ❑ Yes ® No
BuiiLDiNG PERmi r
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT William Gnatek before Building Inspections
has permission to Strip and reshingle roof Inspection on Site--Foundations
situated on 12 Verona 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 penmit.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.
** Install per Manufacturers information: windows, vinyl siding, Building Inspection—Finish
roofs and woodstoves. Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICU PACE -N PREMISES
Certificate of Occupancy --
g Inspector