34-018 (3) Wood Sz"ov<t,
PERMIT APPLICATION CHECK LIST
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Yes No Date
1 . Zoning Form Application
2. Permit Application li
3. Homeowner statement if a licable Lic , ## if not
4. 2 sets of plans
5. Curb cut
6. Water Department. n
7. Permit fee - check only
$. Special Permit rewired with dged if applicable
9. Under section 127 - CMR 780
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
a NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
J Garage
1. Location z t rt L/ l- Lot No.
2. Owner's name Z Address
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
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 i?1 V,- Nom 4-L-1—
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of respoUble applicant
Remarks
PRINTaS'
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Date Filed ��' �L- , File NoJqe1g
ZONING PERMIT APPLICATION (510.2)
1. Name of Applicant: S
Address: Lt- D Telephone: S�-
2 . Owner of Property:
Address: Telephone:
3 . Status of Applicant: ---'Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# 3`F Parcel# ,
Zoning Districts) (include ov rlays)
Street Address Z ✓ cz
Required
5. Existinq Proposed by Zonin
Use of Structure/Property ge5 (l -1�
(if project is only interior work, skip to #6)
Building height
%B1dg.Coverage (Footprint)
Setbacks - front
- side
- - 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 Work/Project: (Use additional sheets
if necessary) �uo0 IDSI-1p yt=
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: 2, % Z Applicant's Signature:
- - - - - - - - - �. - _
THIS SECTION FOR OFFICIAL USE ONLY.
Approved as presented/based on information presented,
Denied as presented
_son Denial:
igna a=zoningpermft Build ---I-n�spector Da tie
NOTE: Issuance not relieve an appl'icant's burden to comply with all zoning requirements and obtain all required permits
from the Board of Health,Conservation Commission,Department of Public Works and other applicable permit granting authorities.
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