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35-011 VIII. ZONING PLAN EXAMINERS NOTES DISTRICT �. USE FRONT YARD SIDE YARD SIDE YARD REAR YARD NOTES i IX. SITE OR PLOT PLAN — For Applicant Use r i 6 I t I r' z a t -e a h € g� f � t ' �� s (` r �a!a at � P r , ,a �" t( „y 4, - i i'-�� ! t +41— e p t f- --I at t 'i"j," `" f i t - f f t {- S �1.d f#re«ra.-j -L 4�E -t s E g b A .d§ ._ -.�-�p^s-vse �j-'a -a t� i_ It —14 ::;-•-d -y+p.: !- -a. 3-1 "a ..;.. 47i_1;4'# T!d y; t 1` ,t -k- -r F �e!& t 4t t � + 4 � : '�° ?p " 1,141 °- + t {� Ti }!. i 44 s r I -tircF d ;. 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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 B Date Plans B Notes 9 Fee Started y Approved y BUILDING $ PLUMBING $ MECHANICAL $ ELECTRICAL $ OTHER $ VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS 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 FOR DEPARTMENT USE ONLY Permit number Building �� Use Group Permit issued z-L 19 � Building Fire Grading Permit Fee Live Loading Certificate of Occupancy $ Occupancy Load Approved by: Drain Tile $ Plan Review Fee �I�Tt:E NOTES and Data — (For department use) h CITY OF NORTHAMPTON OFFICE OF THE INSPECTOR OF BUILDINGS 212 MAIN STREET APPLICATION FOR NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND BUILDING PERMIT IMPORTANT — Applicant to complete all items in sections: 1, Il, 111, IV, and IX. O ZONING 1• AT (LOCATION) �* ��"�� [ -�' "1 ry, ,-i ,! -'% DISTRICT. LOCATION (NO.) (STREET) OF BETWEEN AND BUILDING (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE N 11. TYPE AND COST OF BUILDING — All applicants complete Parts A — D A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use m M 1 ❑ New building 9 Reside ial Nonresidential 2 ❑ Addition(If residential, enter number 12- One family 18 ❑ Amusement, recreational of new housing units added, if any, 13❑ Two or more family — Enter 19 ❑ Church, other religious l Part D, 13)teration (See 2 above) number of units— — — — --> 3,b�I Al 20 ❑ Industrial —r 14 ❑ Transient hotel, motel, 21 ❑ Parking garage 4 ❑ Repair, replacement or dormitory — Enter number 5 ❑ 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) F-1 17� Other - Specify 25 ❑ Public utility 7 Foundation only 26 ❑ School, library, other educational B. OWNERSHIP 27 ❑ Stores, mercantile 81)�fPrivate (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..................... b. Plumbing ..................... c. Heating, air conditioning.......... d. Other (elevator, etc.)............ 11. TOTAL COST OF IMPROVEMENT $ 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 30kMasonry (wall bearing) 40 ❑ Public or private company 48• Number of stories................ Wood frame 41 ❑ Private (septic tank, etc.) 49• Total square feet of floor area, all floors, based on exterior 32 H 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 F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed ....................... 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? Full.......... 54. Number of 46 F-1 Yes 47❑ No bathrooms 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 applic©tliorr- ii his authorized agent. SIGNATU'RE Or AGl`NT i ADDRESS -- - (NUMBER) (STREET) (CITY) APPROVED BY TITLE DATE �g Department of Building Inspections DEPT. FILE COPY 212 Main Street D- ===� Northampton, Ma. 01060 BUILDING • ERMIT VALIDATION DATE_my 5, 19_ 79 PERMIT NO. �g APPLICANT TI"dlGil nd Xurfy, ADDRESS r (N (STREET) (CONTR'S LICENSE) NUMBER OF PERMIT TO Install WIIM ey ( 1 STORY For wood-bun stove DWELLING UNITS 1 (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) ZONING AT (LOCATION) 5 Wat, Earmst Road DISTRICT IN (STREET) rn BETWEEN AND �o (CROSS STREET) (CROSS STREET) O LOT B. SUBDIVISION LOT BLOCK SIZE m a U O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION M Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION � (TYPE) REMARKS: Install masonry chIMey for wood!—burnir stove - AREA OR $ F ESTIMATED COST EEMIT 110-00 VOLUME (CUBIC/SQUARE FEET) OWNER Fdmeaud M. t rtz - BUILDI DE ADDRESS 59 West ftr= Rd ! N ton, BY (Affidavit on reverse side of application to be completed by authorized agent of owner)