36-022 PERMIT APPLICATION CHECK LIST
PAGE PLOT L t .. ZONE I�(IZ. .... l E / #" x_' t ES N0 DAT
1 . ZONING FORM APPLICATION
2 . PERMIT I r
3 . Ow NOT t--
4 . 3 S T LAN
NEW CONSTRUCTION
6 . CURB CUT
7 WATER
8 . REMODELING
9 . ADDITION
0 , ACC QRY STRUCTURE
11 , SIGN / AWNING
12 , PERMIT FEE - CHECK ONLY MONEY ORD R
13 , SPECIAL I D WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - C R 780
15 , FORM A
16 , FILL
COMMENTS :
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70 a
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
a
1 Garage
1. Location /f/� gu✓�/S �f f?� Lot No.
2. Owner's name /Et in Zori mier, Address
3. Builder's name Ad-gel jVlQfi4 Address 16' 000 e41,4D, 6f,1C'4FS104'ti'
Mass.Construction Supervisor's License No. o3Z73 Y . &*/Voao� Expiration Date
4. Addition 1
5. Alteration /.✓�f/� J/lx
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- /7-570-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
l
$ig atur responsible app icant
Remarks
�S
► 4
IN
003510 Date Filed o x,;I q't File No.
ZONING PERMIT APPLICATION (510.2)
1 Name of Applicant:
Address: Telephone: :L-j3
Owner of Property:
Address: i I I A Qa."%r-'s 0 y— 1A Telephone:
(3.l) Status of Applicant: Owner Contract Purchaser
Lessee Other (explain: )
4. Parcel Identification: Zoning Map Sheet#
J Parcel#
Zoning District(s) (include overlays)
Street Address Address //f r r F.- r o
Required
5. Existing Proposed b ' Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg.Coverage (Footprint)
Setbacks - front
- side
- rear f
Lot size
Frontage
Floor Area Ratio ,fi'
%Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume &cation)
6. Narrative Description of Proposed Work/Project: (Use additional sheets
if necessary) ,n„.AZMAA
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 ,
- - - - - - - - - ` - - - - - - - - -
THIS SECTION FOR OFFICIAL USE ONLY:
ZApproved as presented/based on information presented
Den' d as p sented
S or 1:
�t F h � l
5 gnat o Bung---Inspector D to
NOTE: Issuance of a zoning permit does not relieve an appOcant s burden to comply with all zoning requirements and obtain all required permits
from the Board of Health.Conserwation Commission,Department of Public Works and other applicable permit granting authorities.
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