17A-230 (4) PERMIT APPLICATION CHECK LIST
PAGE C'7A PLOT -)30 ZONE Clef3 c7R Lair-e ,� Flo. YES NO DATE
1 . ZONING FORM APPLICATION - 93
2 . PERMIT APPLICATION f�
3 . OWNER OCCUP N ST TEMENT LIC J IF NOT
4 . 3 SETS OF PLANS /PLOT PLAN
5 . NEW CONSTRUCTION
6 . CURB CU
7 . WATER VAIL I T FORMS
8 . REMODELING INTERIOR
9 . ADDITIO
10 . ACCESSORY- STRUCTURE
11 . SIGN / AWNI
12 . PERMIT FE - CHECK ONLY - MONEY ORDER
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 UNDER SECTION 127 - CMR 780
15 . FORM A
16 . FILL
COMMENTS :
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DEPAhIA1ENl OF G1.JlI1 1:1C: (;VSPt'C;'i'IONS
2.12. S;ti .ra; Nluriir,ipzll 13uildino,
INSPECTOR 1Vrcntliau)ptoA, Afnss. 01060
Sol.11i FUE L. RIlRNI:NG APPI.I.kNC:: 6, '.':IIIF^NI 1` APPLICATION PERMIT NUMBER
Location
Owner or T,esser
.i.iIy AYidI-ess) (Tale. No. )
Cont Toff• l.3i' CIJNF/�- _. ----
(N�ir. _) (Address) (Tel e. No. )
RESIi)ENTin NON-RESIDENTIAL
X One [nmi.ly lio-mc, Business
Two or Heim Other
— Ntimbe: of Vni.ts - Sper_i.fy
StoI'ies in BIiI.?.CIi�!c
Typr.. of Appliance
New x Wood burning
�_ Used - Coal.
Labe It�d Combination
Data of 1-lurc:hase Other
W_ Sp0.ci.fy
r
,- M o d F,1 rr r T y i)Ya
Mhnufacturer. ✓//�L` �_ _- ��
Purchased From �r
(Narric of Firm)
(Address)
Cost - Constructi.on h Appliance $
Chimney New Metal Bestos
.__.__. Existing Interior chimney
_ Separate Flue -� Exterior chimney
Other nppliance attacher3 to floc
MasonAry Lined
-� � Unli.ned
Notes & Data:
Signature of Applicant.// —_1
(Address)
Approved By:
Title: Datc
}
Date Filed a- S - 93 v 0005 ',
File No. i 7 A
ZONING PERMIT APPLICATION (510 . 2) U 1?13
1. Name of Applicant: A1A91&6yS(__ ARPI , IM- �,�j,�Address: 22 z,,#1fK sT eph
2 . Owner of Property: 14M,E
Address: - - Telephone: ,- - -
3 . Status of Applicant: X Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# 17A Parcel# Q O r
Zoning District(s) (include overlays) C3
Street Address G
Required
5 • Existing Proposed b Zoning
Use of Structure/Property -SiNG- Moi AW, s,/:
(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
%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) 11Vsnga.4/"eiAJ 0 574;t/�
Ll 12--,2
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: -2b Z-6( Applicant's Signatur
4 4
THIS SECTION FOR OFFICIAL USE ONLY:
Approved as presented/based on information presented FER 25
Denied as presented--Reason:
Special Permit and/or Site Plan Required:
Findi Required: Variance Required:
Sig ure of Bui ng Inspector l0 Q Date
NOTE: Issuance of a zoning permit 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.
i c''71
oQ's�go
Ar �° ti9 "ity of orthampton REQUIRED INSPECTIONS
BUILDING DEPARTMENT
1.. Structural Components in Place*
3. Complete Building*
No.
00 Office of the Building Inspector
Zoning Form No. 000677 Date 2/2 6/9 3Fee $20 neck# 3126
Pagc, i 7 E; Parcel 0 Zone u R$ Section 127 ❑ Yes ❑ No
PE
B 1MW --.MD1NG
U ff� KINH
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Pd a t h a n i e l Arai before Building Inspections
has permission to s n s t a 11 a u.sed w o o d b u r n i n g stove - new c h i m n e ylnspection on Site—Foundations
situated on 99 Lake street InslK ction of Plumbing—Rough
provided that the person accepting this permit shall in every respect Insp action 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, In:,pection 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 L spection 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 h-,issued by this office upon return Insulation Inspection
of this card signed by the Plumbing,Wiring and Building Inspectors. Building Inspection—Finish
li-
Smoke Detectors(Fire Department)
Other
THIS CARD T $E�JISPLAYED IN A CONSPIC C?VS DACE ON THE PREMISES
Certificate of Occupanp _
'ng Inspector
�` 18[!Stlt17