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Vill. ZONING PLAN EXAMINERS NOTES
DISTRICT
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
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IX. SITE OR PLOT PLAN For Applicant Use
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, strut, city, and State ZIP code Tel. No.
Owner or
Lessee �c" c' U
Bui Ider'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
' 1aoc�'e�caoi� �� ��reresz KCB d�
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans
Fee Started y Approved BY Notes
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Number By Permit or Approval Check Dote
Permit or Approval Check Number B
Obtained Obtained y
BOILER PLUMBING
CURB OR SIDEWALK CUT ROOFING
ELEVATOR SEWER
ELECTRICAL SIGN OR BILLBOARD
FURNACE I STREET GRADES
GRADING USE OF PUBLIC AREAS
OIL BURNER WRECKING
OTHER OTHER
VII. VALIDATION
Building q) i - FOR DEPARTMENT USE ONLY
Permit number 4
Building
% Use Group
Permit issued 6 19
Building Q Fire Grading
Permit Fee $_ $'C D
Live Loading
Certificate of Occupancy $ Occ oncy Load
Approved
Drain Tile $
Plan Review Fee $ �J
TITLE
'�► CITY OF NORTHAMPTON
la MASSACHUSETTS
OFFICE of the INSPECTOR of BUILDINGS
Page __ __ Plot �; APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: I, II, 111, IV, and IX. ry O
ZONING
AT
I• AT (LOCATION)
-a""� DISTRICT P /�
LOCATION �
7z AND
(STREETI Q L
OF BETWEEN °� \ _ .�. ANDl.�l..l
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
—•1
1 Q 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— — — — 20 ❑� Industrial
3 ❑ Alteration ("See 2 above)
14 Transient hotel, motel,
21 C—� Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (If multifamily residential, of units ——————— — -i 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 r
6 ❑� Moving (relocation)
17 E-A Other — Speci/y 25 Public utility
7 ❑ Foundation only 26 ❑ School, library, other educational
B. OWNERSHIP 27 Stores, mercantile 1
8 �Private (individual, corporation, 28 Tanks, towers
nonprofit institution, etc.) 29❑ Other — Specify
9 D Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food
DDnprocessing 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..................... �I
b, Plumbing ..................... lti r n
c, Heating, air conditioning........., 1�
d. Other (elevator, etc.).............
A)
11. TOTAL COST OF IMPROVEMENT S
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 L>JsPublic or private company 48. Number of stories...............
49. Total square feet of floor area,
31� Wood frame 41 ❑ Private (septic tank, etc.) �Ll
-- all floors, based on exterior
32 ❑ Structural steel dimensions
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — Specify 42 JR Public or private company 50. Total land area, sq. ft. ........... fOID IQb
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35E] Gas Will there be central air 52. Outdoors........................
36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44 __1 Yes 45 INo 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — Specify ),JC"z- Will there be an elevators 54. Number of Full..........
*�j} bathrooms �iq
46 �� Yes 47 No Partial........
DBUILDING INSPECTIONS BUILDING z9 •�
►, .+ 212 Main Street FtL
Northampton, MA 01060 PERMIT Q
29 - 222 VALIDATION
DATE ,]UlT 92, 19 P RMIT
APPLICANT Francisco Roldan ADDRESS 'z0 cre rook rr., IvIorence owner
(NO.) (STREET) (CONTR'S LICENSE)
Addition Breezwa Y 9& Garage NUMBER OF
PERMIT TO (�) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
120 Acrebrook Drive 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
(TYPE)
REMARKS, permit for the addition of a breezway and attached garage 24_'_ X 24'
AREA OR 576 $Q ft. ESTIMATED COST $ 7,000.00
PERMIT 28.00
VOLUME
(CUBIC/SQUARE FEET)
OWNER Same as Applicant !
BUILDING DEPT.
ADDRESS Same as Applicant's BY
WHITE - FILE COPY • GREEN - FIELD COPY • CANARY - APPLICANT COPY ■ PINK - ASSESSORS COPY P}NT P