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36-263 (3)
PERMIT APPLICATION CHECK LIST a G 3 S r� 193 MCLPIC RldGe. Rd . Yes No Date ` 1 , Zoning Form Application v 2, Permit Application Homeowner statement If a licable Lic , !1 if not d 4. 2 sets of plays 5. Curb cut 6, Water DeRartmPnt, 7,• Permit fee - check only 5 ` 0 8, Special Permit agw-i red. with wed i f aop 9, Under section 12Z - Cg7gn Form A ALovc . PoaL b � o `C3 C n C `ti O tro" a °� n x0 � z o y t� o o I Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations so NORTHAMPTON, MASS. 19 Additions APPLICATION FOR PERMIT TO ALTER Repair �1 Garage L Location /y1,v©/ �� c � Lot No. 2. Owner's name �gYt-Ili-lC �4C�rcG .S) Address 3. Builder's name Address Mass.Construction Supervisor's License No. Expiration Date i 4. Addition o K -- . 5. Alteration 6. New Porch / 7. Is existing building to be demolished? �l 8. Repair after the fire 9. Garage No.of cars Size 10. Method of heating 11. Distance to lot lines Z a?cvf' ��!/S 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§Oqf. Signatu e of responsible applicant Remarks /I PHINUSHOP 4 a i i bate Filed File No. r_ ZONING PERMIT APPLICATION (510.2) 1. Name of Applicant: Address: Telephone: 2 . Owner of Property: -.(o„t c 4 CC Sa-c) Address: .Scr VL1-0 —Telephone: 3 . Status of Applicant: ✓dwner Contract Purchaser Lessee Other (explain: ) 4. Parcel Identification: Zoning Map Sheet# -3 G Parcel# a63 , Zoning District(s) (include overlays) Street Address , g R'dr G fir( Required 5. Existina Proposed by Zonin Use of Structure/Property (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/Projec (Use additional sheets if necessary) .V a 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: ��/96 Applicant's Signature: — — — — — — — — — — — — — — — — — THIS SECTION FOR OFFICIAL USE ONLY: 2 9 / ar. // Approved as presented/based on information presented Denied as presented Reason f fin'al: Signat a of Build ' �-- Inspector Date / - NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits from the Board of Health,Conservation Commission, Departrnent of Public Works and other applicable permit granting authorities. � G G s � CD ID rD CO 0 o � � O' O is •.s `� •dosed. � O '•�- ^� fD cn o I'C CT b C Y A C O A O G M�• M�1 b �• G O 0 UQ :h a N '0 .� i..+• �i CA CA et r G m• fv fl O n rt CA ro w c ti UA G O O �• C A � C H UQ C k fD O UQ C/1 � � n C 'C7 •p b "C3 'C b \J cn �\ to O •,••. cr Q7 el 121 �A„„ / •'S C O � � � I I C � � � � � fD G Q• 'Ly "y, C' � u _ M� UQ Q con N r O v Q cn 9, S. 9