25C-141 (3) PERMIT APPLICATION CHECK LIST
PAGE �� PLOT lj�-/ ZONE �� _h l �'� 2 °` YES NO D �'rE
1 . ZONING FORM APPLICATION
2 . PERMIT A PPLICATION "
3 . OWNER OCCUPANT E O �-
3 SETS OF NS - /PLOT PLAN
5 . NEW CONSTRUCTION
6 . CURB CUT
7 , -WATER AVAILABILITY S
8 . REMODELING I
9 . ADDITION
10 , ACCESSORY STRUCTURE
11 , SIGN AWNING
12 . PERMIT FEE - CHECK ONLY E tR
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. .2 Alterations
a NORTHAMPTON, MASS. �� °\ 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location Y C�Z Lot No.
2. Owner's name(-_,, d��� �sJ�Y �w S Address___
3. Builder's name \ c, Z�,j Address
Mass.Construction Supervisor's License No. -c^T � _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
11. Distance to lot lines
12. Type of roof J' ^-
13. Siding house
14. Estimated cost:-
The undersigned certifies that the abo e statements are true to the best of his, her
L knowledge d belief.
\ Signature of responsible appicant
Remarks —
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Date Filed �' File No.
ZON NG PERMIT APPLICATION (§10 . 2)
1 . Name of App \
scant:
Address :. - Telephone: J -•�
2 . Owner Qf Property: 3�
Address: Telephone : 1oy
3 . Status of Applicant: Owner 4 Contract Purchaser
Lessee Other (explain : )
4 . Parcel Identification: Zoning Map Sheet# o2SC, arcel#
Zoning District(s) (include rlays)
Street Address ov ,
Required
5 . Exis'tin Pro nosed —by Zoning
Use of Structure/Property ��
(if project is only interior work, s ip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
- side L: R: L:
- rear
Lot size
Frontage
Floor Area Ratio
%Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs f
Fill (volume & location)
6 . Narrative Description of Proposed Work/Project: (Use additional sheets
if necessary)
'r
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: J , 'Z Applicant' s Signature:
^THIS SECTION FOR OFFICIAL USE ONLY:
Approved as presented/based on information presented
Denied as presented--Reason:
pecial" Permit and/or Site Plan Required:
din Re ired: Variance Required :
4<1 n ure of Bu ' nspector .6& �� Dat
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, Department of Public Works and other applicable permit granting authorities.
City of Northampton REQUIRED INSPECTIONS
e BUILDING DEPARTMENT 2. Footings and
Components in Place*
3. Complete Building*
No. 1035 Office of the Building Inspector
Zoning Form No. 1966 Date 11/9/93 Fee $20 Check# Money Order
Page, 25C pawl 141 ,Zoe URB Section 127 ❑ Yes ® No
BUI]LDING PERM 1"I
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Wallace Brown before Building Inspections
has permission to Repair slate roof Inspection on Site—Foundations
situated on 47 Orchard Street Inspection of Plumbing—Rough
provided that the person accepting this permit shall in every respect Inspection of Plumbing—Finish
conform to the terms of the application on file in this office, and to the Gas Inspection
provisions of the Statutes and the Ordinances relating to the Construction, Inspection of Wiring—Rough
Maintenance and Inspection of Buildings in the City of Northampton.
Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring—Finish
of this permit.Expires six months from date of issuance,if not started. Building Inspection—Rough
Note:A certificate of occupancy will be issued by this office upon return Insulation Inspection
of this card signed by the Plumbing,Wiring and Building Inspectors. Building Inspection—Finish
Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPIC PLA N THE PREMISES
Gr,rtificate of Occupancy _