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VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
IX. SITE OR PLOT PLAN — For Applicant Use
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NOTES and Data — (For department use)
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IV. IDENTIFICATION — To be completed by all applicants
Name Mai ling address — .v'caber, strcc°t, c ih, '11x1 State ZIP code Tel. No.
17 Z Owner or 'i'."''L! E`�' i✓__!-'� —
t
Lessee 9 M /
�! ./ B u i d ergs
1. . / /' 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
y i Z 17ft
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans By Dote 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 Obtained 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
Permit number
Building
Permit issued 19�
Building
Permit Fee $ if
Certificate of Occupancy s
Appr d by:
Drain Tile � ��
Plan Review Fee _
TITLE
$ Aassarllllsetts
is T Office of the �lns}>er#ox of 'AuilDittgs
APPLICATION FOR
,90 " S 1 ZONING PERMIT AND
Page Plot BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
I•
ZONING
AT (LOCATION) / `-�( 7V//j- ��� DISTR CT
LOCATION NO') (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
f�
II. TYPE AND COST OF BUILDING — All applicants complete Ports A — D 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 12 Xj One family 18 ❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 F—] Two or more fomily — Enter 19 ❑ Church, other religious
number of units— — — — —)� 20❑ Industrial
3 ❑ Alteration (See 2 above)
14 D Transient hotel, motel,
21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (1/multifamily residential, of units ——————— — -i 22 Service station, repair garage
enter number of units in building in 15 ;Kd Garage 23 ❑ Hospital, institutional
Part D, 13) 24❑ Office, bank, professional
6 ❑ Moving (relocation) 16 ❑ Carport
17 ❑ Other — Specify 25 ❑ Public utility
7 ❑ Foundation only 26 ❑ School, library, other educational
B. OWNERSHIP _ 27 ❑ Stores, mercantile
28 ❑ Tanks,'towers
8 Private (individual, corporation,
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..................... 1
b. Plumbing .....................
c. Heating, air conditioning..........
d. Other(elevator, etc.)............
- 11. TOTAL COST OF IMPROVEMENT $
III. SELECTED CHARACTERISTICS OF B ILDING — For new buildings and additions, complete Parts E — L;
for wre=cking, complete only Part J, for all others skip to IV. D
O
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS m
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, ! i
31' Wood frame P
all floors, based on exterior
32 Structural steel dimensions .....................
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY
42 Public or private company 50. Total land area, sq. ft. ...........
34 ❑ Other — SpeciJy ❑ P P y
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ....................... r
Fa PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL O
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 elevator? 54. Number of Full..........
bathrooms
46 ❑ Yes 47 No Partial........
hereby certify that the proposed work is authorized by the owner of record
and I have been authorized by the owner to make this application as his
authorized agent.
SIGNATURE OF AGENT \ __
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
+r z
DEPT. OF BUILDING INSPE�ONS B U I L,D I NG a s
212 Main Street PERMIT
Northampton, Mass. 01 0S 29-2 VALIDATION
� 53
DATE August 18, 19 78_- PERMIT NO. 347
APPLICANT Janet M. Alexander ADDRESS 77 0Ver1QQk Dr-i VA
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Garrage (1_) STORY Detanh DWELLING UNITS
ROP
(TYPE OF IMPROVEMENT) NO. (P .- D USE
7 7 ZONING
7
AT (LOCATION) Overlook Drive DISTRICT TTRA
,(NO.) (STREET)
a BETWEEN " AND
(CROSS STREET) (CROSS STREET)
O�
LOT
m
SUBDIVISION LOT_ BLOCK SIZE
a
U
O BUILDING IS TO BE 24 FT. WIDE BY 24 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
I (TYPE)
K
LL REMARKS: Construct detached gage
AREA OR F� PERMIT
VOLUME �i� ESTIMATED COST ,nnO FEE . 1c) (7n
(CUBIC/SQUARE FEET)
OWNER John An .Tan Pt Al Pxanr]Ar
�,� IL
ADDRESS 77 Chrerinc)k T
1�S'iyP, N' tan
(Affidavit on reverse side of application to be completed by authorized agent of owner)