17A-244 (10) PERMIT APPLICATION CHECK LIST
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PAGE /74, PLOT aqq ZONE UPM �`� YES NO DATE
ZONING FORM APPLICATION (_
2 . PERMIT APPLICATION C
3 . OWNER OCCUPANT NOT
4 . 3 SET PLAN
NEW CONSTRUCTION
6 , CURB CUT
7 , WATER T S
8 , REMODELING INTERIOR
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 . SIGN AWNING
12 . PERMIT FEE - C - MONEY ORDER C1
13 , SPECIAL PERMIT UI D WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - C R 780
15 , FORM A
16 . FILL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
a NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
___. Garage
1. Location �'�` e - �O �' elwe Lot No.
2. Owner's name ?! Address__
3. Builder's name Address
Mass.Construction Su rvisor's L' ens N _Expiration Date
4. Addition
5. Alteration
6. New Porch
7. Is existing building to be demolished?
8. Repair after the fire O
9. Garage Q No.of cars Size
10. Method of heating
11. Distance to lot lines ^
12. Type of roof
13. Siding house I C4 X
14. Estimated cost:-
The undersigned certifies that the ab ve statements are true the best of his, her
knowledge lief.
Sig ature f responsible app,icant
Remarks
4r�N
4
Date Filed File No.
ZONING PERMIT APP`LII�CATIO
�l l
1. Name of Applican
Address : 6M( Telephone : —
2 . Owner of Property: (;J�24 E S� J2 ��oZ
Address : Telephone :
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# Parcel# `� ,
Zoning District(s) (include ove la
Street Addressj'
Required
5. Existinq Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height I-,
%B1dg. Coverage (Footprint)
Setbacks - front
- side L: R: 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 Work/Project : (Use additional sheets
if necessary)
1-
7 . Attached Plans : Sketch Plan Site Plan
8 . Certification: I hereby certify that the information contained he ein
is true and accurate to the best of my knowled e.
Date: Jq1 Applicant's Signatur
THIS SECTION FOR OFFICIAL USE ONLY:
e"/'Approved as presented/based on information presented
Denied as presented--Reason:
S ecial' Permit and/or Site Plan Required:
nd, Re Yed: Variance Required '
S Inspector c�� Da
NOTE: Issuance of a zon� .a 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.
A'71-
City of Northampton REQUMED INSPECTIONS
1. Footings and Walls
BUILDING DEPARTMENT
e � 2. Structural Components in Place*
3. Complete Building*
Nom 693 Office of the Building Inspector
Zoning Form No. 001551 Date 8/9/93 Fee $20 Check# 4600
Page, 17A Parcel 244 _,Zone URB Section 127 ❑ Yes 13 No
BUI]LDINGPERMII
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT BarrV Bouthilette before Building Inspections
has permission to Inspections of existing woodstove & interior stairs Inspection on Site—Foundations
situated on 82 Lake street Inspecticn 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. �k )
Building Inspection—Finish�. , � v
Smoke Detectors(Fire Department)
Other
THIS CARD T B IS LAVED IN A CONSPICU ., S PLA N THE PREMISES
i
Certificate of Occupanc _ ----=°=°'`--
Building Inspector
(Fpf 9:�;If Silb1