29-454 (3) Vill. ZONING PLAN EXAMINERS NOTES
DISTRICT
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
. -
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NOTES and Data — (For department use)
NOW
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and Stag /q Z/IP,`code
� Tel. No.
Owner or t ` 1 V`'�/
Lessee
°-. , Builder's
License No.
Contractor}
3.
Architect or
Engineer
I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to
make this application as his authorized agent and we agree to conform to all applicable laws of this jurisdiction.
Signature o applicant Address Application dote
1
0 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans By Date Plans B Notes
Fee Started Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number By Permit or Approval Check Date Number B
Obtained Obtained Y
BOILER PLUMBING
CURB OR SIDEWALK CUT ROOFING
ELEVATOR SEWER
ELECTRICAL SIGN OR BILLBOARD
FURNACE STREET GRADES
GRADING USE OF PUBLIC AREAS
OIL BURNER WRECKING
OTHER OTHER
VII. VALIDATION
Building )� FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued _ 19
Building _ LJ Fire Grading
Permit Fee $
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
MASSACHUSETTS
$ OFFICE of the INSPECTOR of .BUII,UINGS
V T
Page Plot Y APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. 0
�--� //�� 0 / /�/��p ZONING
I• AT (LOCATION) ���-� �JG —J�..e cam; DISTRICT
LOCATION (NO.) �� (5TREE`T)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V1
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D X
M
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
1 ❑ New building Residential Nonresidential
2 ❑ Addition(if residential, enter number 120 One family 18 E] Amusement, recreational
of new housing units added, if any, 1 Two or more family — Enter 19 Church, other religious
in Part D, 13)
number of unit's— — — — -� 20 ❑� Industrial
3 ❑ Alteration (See 2 above) 14 Transient hotel, motel,
❑ 21 ❑ Parking garage
4 Repair, replacement or dormitory — Enter number
o/ units ——————— — --� 22 L� Service station, repair garage
5 ❑ Wrecking (If multifamily residential, "
enter number of units in building in 15 ❑ Garage 23 ❑J Hospital, institutional
Part D, 13) 16 ❑ Carport 24❑ Office, bank, professional
6 Moving (relocation)
17 �❑ Other — Specify 25 ❑ Public utility
7 ❑ Foundation only 26 ❑ School, library, other educational
B. OWN RSHIP 27 ❑ Stores, mercantile
8 Private (individual, corporation, 28 ❑ Tanks, towers
nonprofit institution, etc.) 29 ❑ Other Specify
9 ❑ Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food
processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement.................. school, secondary school, college, parochial school, parking garage for,
department store, rental office building, office building at industrial plant.
To be installed but not included If use of existing building is being changed, enter proposed use.
in the above cost
a. Electrical..................... O
r
b. Plumbing ..................... ! t
C. Heating, air conditioning.......... t
d. Other (elevator, etc.)............ ( 1
h
11. TOTAL COST OF IMPROVEMENT $
III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and dditions, co plete Parts E — L;
for wrecking, complet only Part J, for all others skip to IV.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
48. Number of stories...............
30❑ Masonry (wall bearing) 40 ❑ Public or private company
41 ❑ Private (septic tank, etc.) 49. Total square feet of floor area,
31 ❑ Wood frame p all floors, based on exterior
32 ❑ Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — Specify
42 ❑ Public or private company 50. Total land area, sq. ft. ..........
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 ❑ Gas Will there be central air 52. Outdoors........................
36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44 ❑ Yes 45 ^ No 53. Number of bedrooms.............
38 ❑ Coal
39❑ Other — Specify Will there be an elevatoO m Full..........
— 54. Number of
46 Yes 47 - bathrooms
❑ No Partial........
DEPILDING INSPECTIONS BUILDING �O h / ,/) r VE)
L ! 212 Main Street OO<IL
Northampton, MA 01060 PERMIT I'
" 29 - 454 VALIDATION
Bob Birdson OATE May 27, 19 86 PERMIT NO. 268
APPLICANT ADDRESS 41 Garf le T s Green Held 47
(NO.) (STREET) (CONTR'S LICENSE)
Repair/Addition One Family Dwelling NUMBER OF
PERMIT TO (_) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION)
56 Crestview Ave. ZONING URA
DISTRICT
(N0.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: permit is to add 5' x 6'6" sliding door, moving existing window, placeing small porch
onto rear of existing building 3 ft. out off of sliding door.
VOLUME ESTIMATED COST $ 1,400.00 PERMIT 10.00
(CUBIC/SQUARE FEET)
Robert Glick
OWNER BUILDING
ADDRESS res view rive BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK ASS SORS COPY P'�NT '1'