10 Langworthy 2018-07-31 (3) City of Northampton
?" 14assachvsetts
rA x
DEPAROMEriT OF NpILDLNG INSPECTIONS i SS
212 Hein street • Municipal Building L
Norttampton, t 01060 str
I=ECPCR
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 TYYP/EOR PRINT ALL INFORMATION
1. Name of Applicant: "�y LU)�— C)gCZ&C
Address: to CfT n1 Gl.f. ZTC�'f gD. Telephone:
2. Owner of Property. }'+" kF
Address: Telephone:
3. Status of Applicant /(Owner _Contractor
4. Structure Location: 2'7A-CK �i O-D
ParcellD: Zoning Map# Parcel# DI
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Useof Property: Single or Two Family'. x MUItIaTI Commercial:
6. Description of Proposed Structure:
One Story Shed under 200 sq.ft.: X Freestanding Deck under 2DO sqfL,less than 30"above grade:
Other(describe)'.
7. Attached Plans: Sketch Plan X Site Plan Plot Plan
8. Does the site contain a brook body of water or wedands? NO K DON'T KNOW YES
EYES 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 BUILDING INSPECTIONS
NORTHAMaTON.IJAC106n
tl
9. ALL INFORMATION MUST BE COMPLETEDPERMIT CAN BE DENIED DUE TO LACK OF INFORMATION.
This cdunn to be Red in by
the Buildin nmem.
Existing Proposed Required by
Zoning
Lot size
Frontage WA NIA NIA
From: N A
Setbacks:
Side: L: R: p L: R:
Rem: I
Haight -�
%Open Space: A '].
(Lai was minae WigsvJ 'V �3�o ti'r2
Pared PwIi
1.1sTE �ytD�`( U� UNUF�
to. Certification:I hereby certify that the information contained herein is true and accurate to the best
of my knowledge.
DATE: 2-0APPLICANT'S SIGNATURE
NOTE:Issuance of a permit does not relieve an applicant's burden to comply with all zd Ing requirements
and obtain all required permits from the Conservation Commission, Department of Public Works and other
applicable permit granting authorities.
r
C;Idr�� [�1flL
Ga�c�SlJu��
� � ��'r'
� � v
� .
s
�'
i