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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 : � 00cA PUrn% Y-1 G C--7Lvv�, �, ��� ��� R I , ' 0.�: -.� � .� �� .���r� �������� ��' sc., ;. 1 i I 4 IJ I I tj't W u _ }3Y�:sruhur. tt:+ o — 1u — 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