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��
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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