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17A-139 (4) PERMIT APPLICATION CHECK LIST PAGE /Z/2 PLOT /j / ZONE ' 'Syr �' ' r ' =%2G YES NO DATE 1 . ZONING FORM APPLICATION ' 2 . PERMIT APPLICATION 3 . OWNER OCCUPANT STATEMENT LIC. # IF NOT 4 . 3 SETS OF PLANS T PLAN 5 . NEW CONSTRUCTION 6 . CURB CU 7 . WATER VAI B T FORMS 8 . REMODELING INTERIOR 9 . ADDITION 10 . ACCESSORY STRUCTURE 11 . SIGN / AWNING 12 . PERMIT FE d NLY - MONEY ORDER 13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE 14 . UNDER SECTION 127 - CMR 780 15 . FORM A 16 . FILL COMMENTS : 2Y- .� � v a' tv b -� � a 0 n R b x O M Z O Z o -� Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. f;ZRZ;�?Z/ Alterations a NORTHAMPTON, MAS . 19 Additions APPLICATIO F R PERMIT TO ALTER Repair � Garage 1. Location t No 2. Owners name Address__ 3. Builder's name -f— ddres Mass.Construction Supervisor's License No. __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 4 �✓ 12. Type of roof ism�✓ 13. Siding house 14. Estimated cost:- �' G U The undersigns i ies at the above statemc are e to the best of his, her knowledge d belie r„q Signature ojresponsible app i.cant Remarks W 4sRyn. H Date Filed 73 001540 File No. ZONING PE T APP O ( 10 . 2) 1. Name of Applicant: Address : G le hone: --G - 2 . Owner of Property: Address : Telephone: 3 . Status of Applicant: Owner Contract Purchaser Lessee Other (explain: ) 4 . Parcel Identification: Zoning Map Sheet# 1-74 Parcel# /,'y , Zoning District(s) (include overla s) Street Address / ,.uL _ Required 5. Existinq, P o osed by Zoning Use of Structure/Property (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 oOpen Space (Lot area minus �. building and parking) Parking Spaces Loading Signs Fill (volume & location) 6 . Narrative Description of Proposed Work/Project : (Use additional sheets if necessary) 7 . Attached Plans : Sketch Plan Site Plan 8 . Certificati I hereby certify that the information contained herei is tru�i � curate to the best of my knowledg Date: Applicant's Signature • THIS SECTION FOR OFFICIAL USE ONLY: Ap oved as presented/based on information presented Denied as presented--Reason: Special' Permit and/or Site Plan Required : F ' di Require Variance Required: S nature f Ming I e NOTE: Issuance of a zoning perm oes not relieve an applicant's burden to comply whii all zoning roquirements and obtain all required permits from the Board of Hoalth, Consarvation commission, Departmont of Public Works and other applicablo permit granting authorities, City of Northampton REQUIRED INSPECTIONS • 1. Footings and Walls e BUILDING DEPARTMENT 2. Structural Components in Place* 3. Complete Building* No. 698 Office of the Building Inspector Zoning Form No. 001546 Date 8/9/93 Fee $20 Check# 3654 Page, 17A Parcel 139 ,Zone URA Section 127 ❑ Yes No BUI]LDING PERMIT * Plumbing and Electrical Inspections required THIS CERTIFIES THAT Bob Thibodo before Building Inspections has permission to Re-cover roof with asphalt shingles Inspection on Site—Foundations situated on 221 chestnut 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 _ U PL ON THE PREMISES Certificate of Occupancy - - ng Inspector f