23B-046 (177) PERMIT APPLICATION CHECK LISTT
PAGE PLOT T ZONE �� � '' `� � �e / YES NO DATE '
1 . ZONING FORM APPLICATION F-
2 . PERMIT APPLICATION
3 . OWNER OCCUPANT STATEMENT IC , # IF NOT
4 . 3 SETS OF PLANS PLOT PLAN
5 . NEW CONSTRUCTION
6 . CURB CUT
7 . WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 . ADDITION
10 , ACCESSORY STRUCTURE
11 . SIGN / AWNI
12 . PERMIT FEE HECKiONLY - MONEY ORDER `
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 . FORM A
16 . FILL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. � / Alterations
NORTHAMPTON, MASS. 191 Additions
APPLICATION FOR PERMIT TO ALTER Repair
J / Garage
1. Location Qwle4 -Pka- ?ion pct. 08. 5D f�rlu01 Lot No.
2. Owner's name Address `
3. Builder's name �, � �� ���- Address
Mass.Construction Supervisor's License No. D `7 Expiration Date ��►y
4. Addition
5. Alteration
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 a,( ' Me4 / "iC c / - d j
13. Siding house
14. Estimated cost:- �
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
V
Sig a e oJ�es n !e app icane
Remarks
OUNG
ROOFING Co.,INC.
Texas Road
Northampton, Mass. 01060
Tel. 413 584.1367 FAX 413 5850226
413 586.9167
:USTOMER DATE � 2/3/95
Cooley Dickinson Hospital
4DDRES$ Locust St. Northampton, ma. 01060
08 LOCATION High rear flat roof. ® � it
;PECIFICATIONS:
Rip the complete roof down to the decking.
Apply 2.8 inch polyisocyanurate roof inGulation. R Value- 20.0
Install Carlisle's reinforced mechanically attaclied roofing system.
• Flash all walls, edges, and roof penetrationsw witli an approved Carlisle detail.
Full the shingles back five courses and re-shingle two courses over the new membrane..
i
Install one'new roof drain and connect to the existing plumbing by a licensed .
plumber.
. In-tall .032 gauge bronze brown aluminum edge metal.
Total Costt $3,900.00
Alternate#1
Frovide.the owner with tarlisle's 10 yeir watertight warranty and 20 year material
warranty.
WE PROPOSE TO FURNISH MATERIAL AND LABOR IN ACCORDANCE WITH THE ABOVE SPECIFICATIONS, FOR THE i
I OF:
Dollars($ 1•
rYMENT TO BE MADE AS FOLLOWS:
material Is guaranteed to be as specilled. Any afteratlon or deviation from above spedfications
slving exUa costs will be executed only upon written orders,and will become an extra charge over and
we the estimate. AO agreements contingent upon strikes,accidents or delays beyond our control. AUTHORIZED ( f��5i�
i ( t
net to carry fire and othesnecessarybsssn ante.All accounts not paid within 30 days are subject to a late SIGNATURE—
sums
rr of VA%per month on the unpaid balance. In the event that legal action Is Imtituted to collect }
due under this agreement,the uisders"d agrees to pay all costs Incurred Including
onable attomey's fees. I
k, rrPjltFlttrP 10f PIM1111001 _ SIGNATURE
The above prices,
-cifications and conditions are satisfactory and are hereby accepted.You are
hoilzed to do the work as specified. Payment will be made as outlined
SIGNATURE
rve. t
UIDOAMn OM f rountlM)M
e of Acceptance
,
Date Filed File No.
ZONING PERMIT APPLICATION
1. Name of Applicant: i�
Address : -' NO y Telephone: c_ r
2 . Owner of Property: �G��� � ' Ia64 iv) /, /
Address :-, Telephone:
3 . Status of Applicant: Owner contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheets ._�3 arcel# V6 r
Zoning District(s) (incl de overlays)
Street Address -f- S Y-- ,
Required
5. Exis-tincT Proposed by Zonin
Use of Structure/Property
(if project is only* interior work, skip to #6)
Building height
%Bldg . Coverage (Footprint)
Setbacks - front
- side L: R: L: R:
- rear
Lot size
Frontage.
Floor Area Ratio
%Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6 . Narrative Description of Proposed ork/Project: Use additional sheets
if necessary) zc" j •
7. Attached Plans: Sketch Plan Site Plan
8 . certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
Date: Applicant's Signature:
- - - - - - - - - - - FFI L - - - -
THIS SECTION FOR OCIAL U8E ONLY:
4' Approved as presented/based on information presented
Denied as presented--Reason:
S Cial Permit and/or Site Plan Required:
J�ihdjoI4 Req ad• Variance Required:
gnatu uildi pector ate
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply witli all zoning requirements and obtain all required permits
from the Board of Hoaith, Conservation Commisslon, Dopartmont of Public Works and other applicable permit granting authorities.
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