32C-212 (9) T �
MI
> �.
Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19_y/ Additions
• Repair
APPLICATION FOR PERMIT TO ALTER
/ Garage
1. Location ` t4 e Lot No.
2. Owner's name 'JAR z em h40 Y2s ki, Address �•
3. Builder's name !�� CR/4 —�I,c.��>E�Q 5 Address �• , N
Mass.Construction Supervisor's License No. ®G !Yo / f �4*//syiy Expiration Date /q9 7
4. Addition //
5. Alteration L
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:-
C,D(�U Ov
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signat of responsible app,icanl
Remarks
10. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
Are there any proposed changes to or additions of signs intended for the property/?YES NO ^
IF YES,describe size,type and location:
11 . ALL INFORMATION MAST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF IWFORMATION.
Th±s ool� to be f127
by the 131- diag Dcpa.rtmeat
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- re ar
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
f 'Parking Spaces
of Loading Docks
Fill:
=(vol-rime--& location)
13 . Certification: I hereby certify that the information contained herein
G} is true and accurate to the best of my knowledge.
DAVE: 7 APPLICANT's SIGNATURE .d'�t�
NOTE: lss ano c0 cn zoning permit does not relieve an ap i oa b den to oompty with all
zoning requirements and obtain all required permits fro a oard of Health, Conservation _
iCommisslon, Department of Publio WorKs and other appilaable permit granting eauthorities.
FILE if
File No.W"Iv,a
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE =,El OR PRIN'T ALL INFORMATION
1. Name of Applicant:
Address: /Y '7 /,i/ q rr,�� c 1 �� M/cyoTelephone:
2. Owner of Property: JD �— , f �(y /}� 7 ,� 6�}jk)s /� r
Address: 0 Z n`1J� �` Telephone:
3. Status of Applicant: Owner Contract Purchaser 'Lessee
Other(explain): /
4. Job Location: /V r Lyd k16
Parcel ld: Zoning Map# Parcel# District(s):
(f0 BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property — It 44<G--/
6. Description of Proposed Use/Work/Project/Occupadon: (Use additional sheets if necessary):
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW V___ 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#
9. Does the site contain a brook, body of water or wetlands? NO - i 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:
(FORM CONTINUES ON OTHER SIDE)
pp FILE # PC 1254
4_ 6
APPLICANT/CONTACT PERSON:.
ADDRESS/PHONE:
PROPERTY LOCATION: 'T� � ' -� -- t?� yQr p tc✓ a
MAP PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
c
_lRerrindeling Interior
Accessory Strurtivre
TH ,VOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION: <'
Approved as presented/based on information presented
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received& Recorded at Registry of Deeds Proof Enclosed
Finding Required under:§ w/ZONING BOARD OF APPEALS
Received& Recorded at Registry of Deeds Proof Enclosed
Variance Required under. § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval-Bd of Health Well Water Potability-Bd Health
-Permit from Conservation miss' n
Signature of Building hispgaor Date `
NOTE:Issuanoa of a zoning permit does not relieve an applicants burden to comply with ail
zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
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