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PERMIT APPLICATION CHECK IST
PAGE PLOT ZONE '9� YES NO QAT
1 . ZONING FORM APPLICATION
2 . PERMIT APPLICATION t---
3 . OWNER OCCUPANT STATEMENT LIC J IF NOT
4 . 3 SETS OF PLANS OT PLAN
5 . NEW CONSTRUCTION
6 . CURB CUT
7 . WATER AI FORMS
8 . REMODELING INTERIOR
9 . ADDITIO
10 . ACCESSORY STRUCTURE
11 . SIG AWNING
12 . PERMIT FEE - CHECK ONLY - MONEY OR D ER
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 . FORM
16 . FILL
COMMENTS :
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p Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No..�ptl-7�t� Alterations
a Garage NORTHAMPTON, MASS. 1-11 19� Additions
APPLICATION FOR PERMIT TO ALTER Re p air
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1. Location .3o J a m o "d V r t Dl"r1' o'p -✓Jb2n Lot No.
2. Owner's name 1 1J VU,V�/ Address_ ct m
3. Builder's name /allow t�omy I/?C_ Address.1�0&ee-S,,We- & PAD 100(0 7 17
Mass.Construction Supervisor's Licensee No.QG0300 3 H,X'. Expiration Date 7-/7-Yy
4. Addition
5. Alteration • ! �/ /zoom
6. New Porch
7. Is existing building to be demolished? �r; l
8. Repair after the fire
9. Garage -- No. of cars Size
10. Method of heating k)
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost:-`��(�O�
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature oJresponsible appicant
Remarks
r
Date Filed �-���GL� 1 002228 File No.
ZONING PERMIT APPLICATION
1 . Name of Applicant:
Address : tii�c',s., _1J_ Telephone:
2 . Owner of Property:
Address : Telephone:
3 . Status of Applicant: Owner Contract Pu chaser
Lessee der (explain: 6,_, LL )
4 . Parcel Identification: Zoning Map Sheet# 3(r Parcel#,12 35',
Zoning District(s) (include overlays)
Street Address
Required
5 • Existinq Proposed by Zonin
Use of Structure/Property )-T- — 's,� G-/i
(if project is only interior work, skip to #6)
Building height
%B1dg. 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 Descri tion of Proposed Work/Project: (Use additional sheets
if necessary) �'Cd J�9,�C'"iyJC�� 71 Q)4)J✓ydo\ _
'r
7 . Attached Plans: t>� 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: , ~I L` ` �Al Applicant' s Signature:
THIS STI F OFICIAL SE ONLY
EC ON OR F U
.
y
Approved as presented/based on information presented
Denied as presented--Reason:
S . ecial' Permit and/or Site Plan Required:
ind' g Req ed• Variance Required:
4 11 "/ 7,�
S' gnature o i1ding or V
,�i a e
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required pormus
from the Board of Health, Conservation commission, Department of Public Works and other applicable permit granting authorities.
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