10 Langworthy 2018-07-31 (2) City of Northampton
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Massachsetts
212nOF B* Hirai i Zl Buil ding 212 Hain Stteat IMnaapel BuildingMA 01060
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 #
PLEASE TYPE OR PRINT ALL INFORMATION
1. NamC'"
go.of Applicant: Qo. roe=�
Addre6s: t O L,0 04 -x M- Tt+�( KD. Telephone: C-(Q
2. Owner of Property: 'j 0+"&r
Address: Telephone:
3. Status of Applicant: A Owner _Contractor
4. Structure Location: 5A-e.IC�i&F=D
ParcelID: Zoning Map# Parcel# Districgs)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Use of Property: Single or Two Family. x Muldfamily:_ Commercial:_ p
6. Description of Proposed Structure: ✓�j 9 r X 9 '
One Story Shed under 200 sq.8.: X Freestanding Deck under 200 sq.fl.,less than 30"above grade:
Other(describe):
7, Attached Plans: Sketch Plan X She Plan Plot Plan
8. Does the site contain a brook body of water or wetlands? NO )< DON'T KNOW_ YES_
IF VES: Has a permit been,or need to toe,obtained frau the Conservation Commeaion?
Needs to be obtained Obtained Data issued
RECEIVED
CONTINUED ON NEXT PAGE JUL 3 1 2018
(SEPT OF BUILDING INSPECTIONS
/ n NORTHAMPTON.MA 01060
N i
9. ALL INFORMATION MUST BE COMPLETED: PERMrr CAN BE DENIED DUE TO LACK OF INFORMATION.
The colunn to be filled in by
the Building Department.
Existing proposed Required by
Zoning
Lot Size
Frontage WA NIA N/A
Front: N A
Setbacks: it
Side:
L: R: � L: R:
Rear. Y
Height ti ��
(Ld area minus bldgaM � �3�a A.
Paved parking)
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10. Certification:I hereby certify that the information contained herein is true and accurate to the best
of my knowledge.
DATE: 2-1--nibIck APPLICANT'S SIGNATURE
NOTE: Issuance of a permit does not relieve an applicant's burden to comply with all nhg requirements
and obtain all required permits from the Conservation Commission, Department of Public Works and other
applicable perm[granting authorities.
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