38B-040 (4) /\ �-'---
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PERMIT APPLICATION CHECK LIST
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Address :
' Tom Yes NO Date
1 I0DiDg Form Application
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2 � � op tAliCdtiUn �' V
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3' Homeowner statement if dDDliCOblg/LiC . if not
4. 2 sets Of 0\aDG
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5, Curb cut 6. Water Water De-partment mpmn -- --
7. Permit fee - check only "v
8, Special Permit require-d- with deed ifayln] ilab}e
9. Under S8CtiOO 127 - M 780
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1O, Form A
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-^ Date Filed 11- 15-9) \��� File. No,
ZONING PERMIT APPLICATION (§10 . 2) ^
1 . Name ,of A p p l i c a n t: 1�De`t'► &N—I 640 2 fiel s n S (char fes -1- 0w1Ps to abtoode& c-.1,-)
. Address : tto-1 ,0Lro,.t. bT; XoQnfAv, pro.n3 Telephone : g-k1,-a53c L
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• 2 , Owner of Property: kJpal-y 4 T eXT'b7LPiels 5
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Address : •>t,'1 Sou14 ' T •Ivor pr-o-N Telephone: 5y16 -r34C_.__
. 3 . Status of Applicant: wner Contract Purchaser
Lessee Other (explain: ).
' 4 , Parcel Identification: Zoning Map Sheet# 8Ta Parcel# () ,
• - ZoningDistrict (s) (includs-.ovgr�l.�a,�js) Gt../��
Str.fretg Address `` �C �7�
C.
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Required .
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5 , P;xistinq ' Proposed byV,oninq
• Use of Structure/Property
• (if project 'is only interior work, skip to #6 ) .. .
• • Building height •
: *Bldg . coverage (Footprint)
1 S.etbacks - front
- side ' i ,T •
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- rear
' Lot•'s i z e
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. . Frontage
• . . • Floor. Area Ratio
%Open Space (Lot area minus � • •
. . • building and parking) , .
• Parking Spaces ._. _____�....___
Loading
Signs _..
. • Fill (volume & location) Ado . -
6 , Narrative Description• of Proposed Work/Proj,ect : (Use additional .sheets
. if necessary) Per641+' 4b AO.-c..a3 ' Cil- 10 TineL Al— 2 +4Ie orl-
: •9 , 'TY .. 1-------
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' 7 . ' Attached Plans : Sketch Plan Site Plan
• 8 . . Certification: .I ' hereby certify that the informat n contained herein
' is true and accurate to the best of my knowl
. .Date: (V-' `5 -c) l Applicant ' s Signatur •
• • THIS SECTION FOR OFFICIAL U ONLY: . . ,
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• • Approved as presented/based on information presented .
Denied as presented
Reason for Denial : .
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'Signature of Building Inspector • Date "—'
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NOTE: Isauancu of zoning permit Bova not relieve an applicant's burden to comply with all zoning requirements and obtain I Nquirad I;c,nrrts
from tho 8oard.o(Hoallh, Conaorvation Commlaalon, Dopartmont of Public Works and other applicable permit granting outhoriU a.
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
io.'. � NORTHAMPTON, MASS. j(I '4-1 19 611 Additions
inn die Repair
eh` APPLICATION FOR PERMIT TO ALTER Garage
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1. Location \c9`A So t)T\- ST N 0.C-T I n o tJ Lot No.
2. Owner's name N O PST- — i5e Ri se S Address
'1') GrGLL- /C-ha1-hr T30wA-aS
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4.
5 � !f00 dtaizc�
rIGlgGa,,,U
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
13. Siding house
14. Estimated cost- gD a
The undersigned certifies that the above statements are true to the best of his, her
kno n lief.
.Z.____-- ,
C,S,E
gnatur . ponsible applicant
Remarks
P,YNHP