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17A-193 (4) r1 ,PE/RMIT APPLICATION CHEC LIST PAGE 16 �7 y� PLOT Pq3 ZONE a2�/`" ue,�2�F YES NO DATE 1 . ZONING FORM APPLICATION X11 Q5 2 , PERMIT APPLICATION 3 . OWNER OCCUPANT E # IF NO v 4 . 3 SETS OF S PLAN 5 . NEW CONSTRUCTION 6 . CURB CUT 7 . WATER S 8 . REMODELING INTERIOR 9 , ADDITION 10 . ACCESSORY STRUCTURE 11 . SIGN AWNING 12 . PERMIT FEE - CHECK ONLY - MONEY ORDER 13 , SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE 14 . UNDER SECTION- 127 - CMR 780 15 . FORM A 16 , F I L L COMMENTS : tic.`elCfiv�� wl 3 r � z pm Z ' V M � 1 I � I � Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MASS. /Z� 4c C /� 2: 19 — Additions /�-��p E L APPLICATION FOR PERMIT TO ALTER Repair /�e� j Garage Location l� d'��,tl L 5 % A�1W A/Ti7 12 A, Lot No. Owner's name C,C-/i H./J t N zi lti�C�/ l�/9/��'�SS dress lJ Dl U -L 3 Builder's name-<cw,�,c atc ),gAl-& Address 16 1f /'`�fiWif- �S7- Mass.Conswction Supervisor's License No. G�. � i3 Expiration Date tddition 5Alteration L �j f l C /{z�w /C'f 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. stimated costal r The undersigned certifies that the above statements are true to the best of his, her knowledge and ief. Signature of responsible app icanl Remarks r j t 'v Date Filed z e/ 7 _ File No. ZONING PERMIT APPLICATION (5 10. 2) I/ Name of Applican Address: ,Telephone: 2 owner of Proper: c Address: �- Telephone: OE , 3 . Status of Applicant: owner Contract Purchaser Lessee Other (explain: ) 4 . Parcel Identification: Zoning Map Sheet# 110� Parcel# 03 , Zoning District(s) (include Terl th1Vl1� Street Address r Required 5. Existincr Proposed by 2onin Use of Structure/Property (if project is only interior wo4k,D ski to #6) Building height 9.-Bldg. Coverage (Footprint) Setbacks - front - side L: R: L: R: rear Lot size Frontagie. Floor Area Ratio oOpen Space (Lot area niinus building and parking) Parking Spaces Loading Signs Fill (volume & location) 6 . Narrative Description of Proposed work/Proj ct: (Use additional sheets if necessary) / ,� ).P ,z-- 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: s Applicant' s Signature: -1 THIS SECTION FOR OFFICIAL U8E O LY: /Approved as presented/based on information presented Denied as presented--Reason : Spe al* Per and/or Site Plan Required: F' i Re e Variance Require Wntu f u�ld�ng I ct D e NOTE: lssuanco of a zoning pe does not reflove an applicant's burden to comply witli all zoning roquiroments and obtain all requirod pormits from tho Board of Hoalth,Conservation Commission, Dopartmont of Public Works and other applicable pormit granting nulhoritlos. City of Northampton REQUIRED INSPECTIONS e BUILDING DEPARTMENT 2. Stuccttugral and Walls Components in Place* I Complete Building* No. 133 Office of the Building Inspector Zoning Form No. 003925 Date 3/9/95 Fee 40 Check# 40 Page, 17A Parcel 193 ,Zone URB Section 127 ❑ Yes ® No PERMIT Bun-JDING i * Plumbing and Electrical Inspections required THIS CERTIFIES THAT serge Belanger before Building Inspections has permission to Remodel kitchen Inspection on Site—Foundations situated on 30 Poo;el 1 street Inspection of Plumbing—Rough f Ca Y/\ 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 S of this permit.Expires six months from date of issuance,if not started. Building Inspection—Rough Note:A certificate of occupancy will be issded 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 D!,5PLAYVD IN A CONSPIC JSTLACE THE PREMISES Certificate of Occupancy Building Inspector - (,�p't 1:1;11 Si1��1