10 Langworthy 2018-07-31 City of Northampton
Massachusetts ��'
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iL t ART1gNT OF SOLLDLRG ZRSPZCrZORS n
t _ 212 Main Street • Hun 010 aviltling
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—a' Noramptan, MA Olofio
ACCESSORY STRUCTURE PERMIT APPLICATION
(For freestanding structures less than 200 sq. ft., at least 5 feet from any other structure)
Permit Fee: $30.00 Check #
n PLEASE TWEE OR PRINT ALL INFORMATION
m
1. Nae of Applicant: Cr•4ct�� &z Z +y tuCc..yra
Address: W L-+A1C2( rt+� AD. Telephone: Lt C3 SYd6 s6tt1
2. Owner of Property: S 0+KL
Address: Telephone:
3. Status of Applicant Owner _Contractor
4. Structure Localw pmt ^
Parcel ID: Zoning Map# Parcel# Distdct(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Use of Properly: Single or Two Family x MullHamily: Commerdal:_ O
6. Description of Proposed Structure: / `
One Story Shed under 200 sq.fL: X Freestanding Deck under 200 sq.ft.,less than 30"above grade:
Other(describe):
7. Attached Plans: Sketch Plan X Site Plan Plot Plan
8. Does the she contain a brook,body of water or wetlands? NO X 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
RECEIVED
CONTINUED ON NEXT PAGE
DEPT OF BWIDING INSPECTONG
` n NOMTHPMPTON,MA01060
7/31 /jL
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9. ALL INFORMATION MUST BE COMPLETED: PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION
This colunn to be filled in by
the Buildtnq Devaninent
Existing Proposed Required by
Zoning
Lot Sim , (�-5 C.P&W E
Frontage N/A WA WA
Front: NIA
Setbacks: p
Side. L: R: L: R:
Rear: Y
Height
YO
Space: A
(Lo[area minus bldg and ',
Paved narking;
&ww FAoFk;zz"( Lot UNC.LFAIZ
10. Certification: I hereby certify that the information contained herein is true and accurate to the best
of my knowledge.
DATE: 43 I APPLICANT'S SIGNATURE
NOTE: Issuance of a permit does not relieve an applicant's burden to comply with all ing requirements
and obtain all required permit from the Conservation Commission, Departrnent of Public Works and other
applicable permit granting authorities.
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