29-420 (2) ZONING •
FRONT DISTRICT
USE
SIDE • . SIDE YARD
MORE, I
IX. SITE .......
OR PLOT
/$�w•w•.. ••. .•woowo..•o•
•• '.' r w r �• i i i s •pia iaariitwriMuaiuu.i /alsa�i Sam ::::::::M:
+�a�= ••H■f.a.H.H.■r:� • 1111H1=.. ....snarl■nHH■•n Hr pr/HH■p//H.H■H an l.HHHOr
■ • » ■ ■ H. H • » ■HH• Hrnppo.oHOrr
: • �� w� ■:: : H:�"n" � =■■i■•nu:Ha•=nHUH•uHp•
no
sun Hr • ■ • Hf ■nsr■•r:H•nnnH #.ouaHSnoo
r r # aH ■uru oa 1■ aua .Hun■ apnurnH
ariaa � • � � .� aN •�■�•s:�pl�»:SIN■=u•ra•u:rHHruao■
s i 'i� N H rN3■■Hr{■ro.HUwapnr{•.
•� yi.ir•.w�i . : _ # • • r��� • rwl• • • �ylr i■:a�nu'as au1�n1H1�.rt.Hru#fH■
■ { • u n ri •ra t ■r• nr HHHH /Hp s»H• HHHHp.Hr
w p•!•• i �:r■;r •. :. a �jjry :a■ . ��i��.a•:i■rp■■ ••:::.rf::::■Y�:N:.:
.! �•■IH a �IIt1u �•■ aPIr H==N:rNH-�f .. .HH■H
.{{• rill� ■ •i tH"iiH HuHHHHrH..Los so
f : r • : • H .Ha !# # .r •H gn■e.�a�! _4#p•� n r ■ ifri:f■ .a/:a■■.RH.//■■i.Hr..iM.0.4"
a is wl ■ •. w It:.■.# HY:H • r ■ n •:�••Y H ■H■Hp»n.pH a■■H■H■•f
• .rnn•: :a : i::: iH:::.=rf»....... H#:H H-Hpf•
r Yn ■ ■ . . rH puuo ■.HaapuuoHSHHpr{H
�: • �+• �� �•ulY•�ns•:: �a•r �.#•� a � ciY. •■. i..HH•=a•..Hr•aa.•H./HH■n•p»Hn
r: �: H e■ w5i Hrr • rr. • N H H r•.r H• lnnr.r.rHaap■HpH.pp■/H
n . • • ! ra a n ::°iw r • HNrHUprun n a»Hero
��.'r�s :: r '�._• ■ rata :::W:: i. :•■NUGH
Ui�n• . .' ii. irt ::::= H •_■ . sia�a�:iii::::::::=:i:i wail:
i ra:H pr r r t p.HHH■HH•H.n.Hp
= .� • •■ i#a: :iiiw a:::=:■ :U:::::isHH011 :
• � • •� ■■ � ���1#r■ ■ ■�. a.raHi:iia•:nnHHa•up
■ a■ _ r • ■ Hrr»papo■»HOOH
■: :ia:::a: ai:• r� as »N •�arSr •:{ was::ii:ii:::""MO HNNU::
■ r. :Sn►frrr•L. !- :r : �Ir ria: ■.•Ha=.: ■ :C::::::some::::
• i H •irii�:ni: i• i sr:i!as :i _■ i w � a=�■a �i
H H H HH o�1 ■ r {H H• a SUH■.HH•
i.»a ■ j.■ N . 11■■ •1��1 ��*� r�e�* .• H H �e►r =��..�ry■�=rwta•• ■ � �Nr �■ •a •�•� r»■ p.■ ap s son rroH■
i�w ai ,■ :•:i'�i/4i■:PuiHa:a::a"rN :■ :••::ar N1�N: ��Hamass i a•w»::
�j ■ r 1Nr • r • n ■ • »r • u ■ Nur r■on H-
» i t ii:w :�i.H■»H n:Srr::arid. Na••:w:r :aa. H .n . H:::f:n :Hn:H�iaHH :HHHri■i
■r r • r •■.rnl�srna •■ • Hra rn■. H rs.a r r . • rte■ ■H■ m uH■ rr
i ■ r _ •H: �YV ar ..:i •i■HH.H�i n: r:: :�_�11 : ��:�■�� ��11 _:�yi::a :yr�i::�i1��Gi■:iu■Ooi1.,H:� ■:i:i:a
N ■ i. .•• i. :. a::�=HHH�Zr:aH:r� �iii�aa�ii:i■aa::a��■ai:=a� =:n{••it»Na A H».NH:
: t: •:ifr••:»:::a. HHH .Hares ■r■ H ps H{ uu Hiir.. r11prn■•uH■
• r �•a=»rr�iw•;106=: =la•#rN■ •a:: i::: ::::in�;.Hr 111 ■ :::wi ww : •
do
NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, strcct, cifN, and Stcrtc ZIP code Tel. No.
Owner or
Lessee �� 06 1 1
1. — —
Builder's
L.
Ll tense 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 author 1404agent and we agree to conform to all applicable laws of this jurisdiction.
a ure applicant rA. �' Address Application date
. .fin, cL
00 0T 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
VII. VALIDATION
Building y�
Permit number G�
Bui Iding
Permit issued /4 19
Bui Iding
Permit Fee $ �A —
----
Certificate of Occupancy $
Approved by:
Drain Tile
Plan Review Fee S—
TI
City of Xort4ampton
'� � �lttssticlptsctfs
T' t®ffzce of thefns}lertnr ofttilDings
�� APPLICATION FOR
Q
Page Plot ZONING PERMIT AND
a
9 BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. p
!'7 ZONING
I• AT (LOCATION) . tl �rs S DISTRICT[.
LOCATION (NO•) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D m
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use m
1"K New building Residential Nonresidential
2 ❑ Addition(If residential, enter number 12❑ 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- - - - -o- 20❑ Industrial
3 ❑ Alteration (See 2 above)
14 ❑ Transient hotel, motel, 21 ❑ parking garage
4❑ Repair, replacement or dormitory - Enter number
5 F-1 Wrecking (If multifamily residential, of units -------- - 22 Service station, repair garage
enter number of units in building in 15 ❑ Garage 23❑ Hospital, institutional
Part D, 13) 16 ❑ Carport 24❑ Office, bank, professional
6❑ Moving (relocation) �-
17X Other - Specify 1' '' 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
i'
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, 11
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 -t1
a. Electrical.....................
b. Plumbing .....................
c. Heating, air conditioning.........
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT $ Cr 6 -1
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. D
Q
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS m
�._h1 48. Number of stories..............
30�� Masonry (wall bearing) 40 ❑ Public or pr va company
❑ c tank, etc.) 49. Total square feet of floor area,
31 41 Private (septic se ti' Wood frame all Floors, based on exterior
32 Structural steel dimensions .....................
H. TYPE OF WATER SUPPLY, r+
33 Reinforced concrete /�__Ilr
42 Public or private company-_om "~ 50. Total land area, sq. ft. ...........
34 ❑ Other - Specify ❑ p
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ....................... r
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL O
35 ❑ Gas Will there be central air 52. Outdoors........................
conditioning? �1-'>r- `-° -'
36 ❑ c
Oil �/2 =---' L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44 ❑ Yes 45 ❑ No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other - Specify Will there be an elevator? 54. Number of Full..........
46 ❑ Yes 47❑ No bathrooms Partial........
A za a a'u
P%a on W4
777 e
roll...� .:fir s-.wu.c
MIS
cop
UK
Mu am ow—
w3
�"
r `§
tz a �
"ITZ ra '7. 4 '1
€,
. ya..
MINIS
V
k a�
,
Y w bar
M
4
I hereby certify that the proposed work is authorized by the owner of record
and t have been authorized b' the awner to make•t rrs rp `io€i eiFS Ais
authorized agent.
SIWA-TURF`Of AaGENt _
ADDRESS ....
(NUMBER) (STREET) {CITY)
APPROVED BY TITLE
DATE 19
DEVI. rim �.... .
Z❑
CITY OF WORM= BUILDING a a
NORTHAHMNr Mme. PERMIT VALIDATION
29-1$�-
DATE iSomtember 16„ 19-.22_ PERMIT NO. rt
APPLICANT Riabard 3• F1114tt9.l-"r�l i ADDRESS
(N .) (STREET (CONTR'S LICENSE)
��p ux, a7h�f1 NUMBER OF
PERMIT TO ��UCs SR�9ed (�) STORY ..DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION)
Golden Dri ve o STR CT. U
(NO.) (STREET)
a BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
n SUBDIVISION LOT BLOCK SIZE
m
0 BUILDING IS TO BE 6 FT. WIDE BY 12 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
I (TYPE)
K
� REMARKS: zRaltx1a"Im Erect Aiyv Shy --
AREA ESTIMATED COST $ 600,00 FEEMIT $ A 00
VOLUME E d
(CUBIC/SQUARE FEET)
OWNER Luol Losomaki BOIL NG PT.`
ADDRESS 102 S=109 H'17 d ve BY
(Affidavit on reverse side of application to be completed by out orized agent of owner)