29-385 (2) VIII. ZONING PLAN EXAMINERS NOTES
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
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NOTES and Data — (For department use)
Now
IV. IDENTIFICATION — To be completed by all applicants
Name / Mailing address — Number, strut, city, and State ZIP code Tel. No.
Owner or
Lessee
f� ✓ J Builder's
2
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 of applicant Address Application date
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans By Date Plans By Notes
Fee Started Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date
Permit or Approval Check Obtai ed Number By Permit or Approval Check Obtained Number By
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
V11. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building. Use Group
Permit issued IALAA U4 19
Building Fire Grading
Permit Fee $ +
Live Loading
Certificate of Occupancy $ Occupancy Load
Drain Tile $
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
MASSACHUSETTS
$ OFFICE of the INSPECTOR of BUILDINGS
Pagel Plot APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete
all items in sections: 1, 11, III, IV, and IX. O
ING
I• AT (LOCATION) L= C��"` �(.J' [/���'V � i DIOSTR CT
LOCATION (N0.) (s'rREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
Vr
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D -a
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
M
1 ❑ New building Residential Nonresidential
2❑ Addition(/f residential, enter number 12X One family 18 ❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 ❑ Two or more family - Enter 19❑ Church, other religious
number of units- - - - --> 20❑ Industrial
3 Alteration lSee 2 above) 14 Transient hotel, motel,
21 ❑ Parking garage
4 Repair, replacement or dormitory - Enter number
J
5 Wrecking (If multifamily residential, o units ——————— - ->. 22 ❑ Service station, repair garage
❑
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13) 16 ❑ Car P or! 24❑ Office, bank, professional
6 Moving (relocation)
17 ❑ Other - Specify 25 ❑ Public utility
7 ❑ Foundation only 26 ❑ School, library, other educational
B. OWNERSHIP 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
q processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement,,,,,,,,,,,,,,,, C 0 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.......................
b. Plumbing .....................
c. Heating, air conditioning..........
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT I$ �dG
III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L;
for wrecking, complete only Part J, for all others skip to IV.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
30 Masonry (wall bearing) 40 ❑ Public or private company 48. Number of stories..............
31 ❑ Wood frame 41 (septic tank, etc.) 49. Total square feet of floor area,
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
A PARKING SPACES
F. PRINCIPAL TYP OF HEATING FUEL I. TYPE OP/MECHANICAL 51. Enclosed .......................
35 Gas Will there be central air 52. Outdoors........................
n
36 ❑ Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
�� ,
37 j Electricity 44 LJ Yes 4 No 53. Number of bedrooms..............
38 ❑� Coal / �,
39 Other - Specify Will there be an erev or F .
46 54. Number of
46 C-1 Yes 47 ❑ No bathrooms
Partial.......
)epartment of Building Inspections
!12 Main Street ~
dorthampton, Mass.-A 0 BUILDING Z j &) • DO
MEL
M
29 - 385 PERMIT
VALIDATION
DATE August 279 19 $4 PERMIT NO. 381
APPLICANT Marcia lK. Lutz - Cross ADDRESS 35 Brookwood Dr., Flo. Owner
(NO.) (STREET) (CONTR'S LICENSE)
Alteration One Family ome NUMBER of
STORY Y DWELLING UNITS
PERMIT TO
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
35 Brookwood Drive Florence ZONING URA
AT (LOCATION) DISTRICT
(NO.) (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
7�p (TYPE)
REMARKS: permit to break through the foundation and install cellar door to outside
AREA OR n/a ESTIMATED COST 2,000.00 PERMIT .� 10 0. 00
VOLUME ST
(CUBIC/SQUARE FEET)
OWNER Same as applicant
BU 4N �
ADDRESS Same as above BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - A SESSORS COPY