Building Permit Application(Signed) (2)APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address This section to be completed by office
Map Lot
Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
2.2 Authorized Agent:
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Building Permit Fee
This Section For Official Use Only
lhasbrouck northamptonma.gov
221 Park Hill RdNorthampton, MA 01062
Effrosyni D. Kokaliari 221 Park Hill Rd Northampton, MA 01062
413-320-9790
22,608
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side
Rear
L:______ R:______ L:______ R:______
Building Height
Bldg. Square Footage %
Open Space Footage
(Lot area minus bldg & paved
parking)
%
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit/Variance/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 #
B. 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:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES NO
IF YES, describe size, type and location:
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House Addition Replacement Windows
0r Doors
Alteration(s) Roofing
Accessory Bldg Demolitio New Signs ] Decks Siding Other
6a If New house and or addition to existing housing, complete the following
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Patrick D. Rondeau
Install an 18 panel roof mounted solar array. System size 7.2kW DC.
Effrosyni D. Kokaliari
12/30/2021
01/03/2022
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:
Name of License Holder
9. Registered Home Improvement Contractor:
Company Name
SECTION 10- WORKERS’ COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6))
2
115680
4/9/2025
Patrick D. Rondeau