17A-083 (5) PERMIT APPLICATION CHECK LIST
PAGE / '7/-, PLOT ( "" 3 ZONE c� L' r� t r1 �:; YES NO DATE
1 . ZONING FORM APPLICATION
2 . PERMIT APPLICATION
3 . OWNER OCCUPANT STATEMENT Z LIC .# IF NOT ` ' � f
4. 3 SETS OF PLANS PLOT PLAN
5 . NEW CONSTRUCTION
6 . CURB CUT
7 . WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 . SIGN Z AWNING
12 . PERMIT FEE — CHECK ONLY — MONEY ORDER Al -/-C' cr
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. Alterations
STti NORTHAMPTON, MASS. 19 c?'% Additions
Repair
APPLICATION FOR PERMIT TO ALTER
Garage
1. Location Lot No.
2. Owner's name Address 1 4 C ct,e ti,.,
3. Builder's name , �' t� Address -10 .fir c" -ry-
Mass.Construction Supervisor's License No. 0111511 Expiration Date
4. Addition
5. Alteration t/
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:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible applicant
I
Remarks � `—
C.
PR
any
0000
Date Filed File No. i-18
ZONING PERMIT APPLICATION (§10.2) (j R A
1. Name of Applicant:
/ �
Address: i l-( c, c,,.0 ,� ,� 0 ,1+ �k , " Telephone: S 7
2 . Owner of Property:
Address: j q , % k— Telephone:
3 . Status of Applicant: ', Owner Contract Purchaser
Lessee Other (explain: )
/ 1 0ga 004
4 . Parcel Identification: Zoning Map Sheet 7 Parcel# ,
Zoning District (s) include overlays) rlpj' Q
Street Address ,�1
Required
5 . Existinq Proposed bv Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
xiBuilding height
%B1dg.Coverage (Footprint)
Setbacks - front
- side 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 Description of Proposed W rk/Project: (Use additional sheets
if necessary) ,_ n r -
n
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:
4
THIS SECTION FOR OFFICIAL USE ONLY:
roved as presented/based on information presented
Denied as presented
Reason for Denia :
r 4
Signa e of 'Building Ins or " � Date
NOTE: Issuance of a zoning&ewffl: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.
7 /n' rync
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lot
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ma COST
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City ®f Northampton REQUIRED INSPECTIONS
1 . Footings and Walls
BUILDING DEPARTMENT 2 . Structural Components in
Place
3 . Complete Building
No. 293 Office of the Building Inspector
f
Date JUNE 13 19 91
RMIT
BUI DING P
1
THIS MAY CERTIFY THAT EDWIN H. EVERETT Insp. on Site — Foundations 1.r
has permission to ADD 61X12' to kitchen & bay window Insp. of Plumbing — Rough
situated on 19 CAROLYN STREET' (F O.) Insp. of Plumbing — Finish
provided that the person accepting this permit shall in every re- Insp. of Wiring — Rough r—� f'
spect conform to the terms of the application on file in this office,
and to the provisions of the Statutes and the Ordinances relating Insp. of Wiring — Finish ' IL T/
to the Construction,Maintenance and Inspection of Buildings in Insp. of Health (Septic Tanks)
the City of Northampton.Any violation of any of the terms above
5 '
noted is an immediate revocation of this permit. Expires six Building Insp. — Rough
months from date of issuance, if not started. Building Insp. — Finish
Note: A certificate of occupancy will be issued by this office upon
return of this card signed by the Plumbing, Wiring and Building Smoke Detectors (Fire Dept.)
Inspectors. Gas Inspection
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLA E O THE PREMISES
Certificate of Occupancy
Building Inspe
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