35-220 (7) VII-1. ZONING PLAN EXAMINERS NOTES
DISTRICT
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
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NOTES and Data — (For 6cpo,men use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — `'umber, street, city, and State ZIP code Tel. No.
1.
Owner or /` l y; Y1�i� /,!r )
Lessee
7 r Builder's
Contractor License No. P!
_
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 Addres ? Application date
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date P y Ions B Date Plans By Notes
Fee Started Approved
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 Date 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
yC Use Group
Permit issued '�- ' J .4j 191
Buildin g _ y / Fire Grading
,. / f'
Permit Fee $
�- Live Loading
Certificate of Occupancy $ Occupancy Load
Approved bpDrain Tile �
Plan Review Fee $
TITLE
�3 ,. - CITY OF NORTHAMPTON MASSACHUSETTS
OFFICE of the— INSPECTOR of BUILDINGS
Page Plot APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
I. -� j , J�.� ZONING
AT (LOCATION) /^� �. r //C /r/t _ _ DISTRICT C`
LOCATION (NO.) (STREET)
OF BETWEEN /J17F /�Zt �'4- AND
BUILDING CROSS STREET) CROSS STREET)
SUBDIVISION LOT BLOCK SIOZE ��jU.'
Vr
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
M
1 New building Residential Nonresidential
2 ❑ Addition(If residential, enter number 12 NJ One family 16 ❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 F7 Two or more family - Enter 19 ❑ Church, other religious
number of units- - - - 20 L❑ Industrial
3 ❑ Alteration (See 2 above) 14 l
l
t
h
i
Transent hotel, mote ,
❑ 21 ❑J Parking garage
4 `❑ Repair, replacement or dormitory - Enter number
5 ❑ Wrecking (11 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)
7 ❑ Foundation only 17 ❑ Other - Specify_ 25 ❑ Public utility
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
processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement,,,,,,,,,,,,,,,, J U(�(j 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 e
a. Electrical..................... 3eo I
b. Plumbing ..................... 4r,f
c. Heating, air conditioning.......... 000
d. Other(elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT I$ r
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 jo Private (septic tank, etc.) 49• Total square feet of floor area,
all floors, based on exterior r,�( 0_
32❑ Structural steel dimensions ..................... G/
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other - Specify 42 F5el Public or private company 50. Total land area, sq. ft. ........... (1
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........................
conditioning?
36 � Oil L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44 L Yes 45 No 53. Number of bedrooms..............
38 Coal
39 ❑ Other - .Specify Will there be an elevator? Full..........
54. Number of
46 1 Yes 47 ❑ No bathrooms
Partial.......
DEPT. OF BUILDING INSPECTIONS BUILDING ZO `
! 212 Main Street � `'
b
Northampton, /MBA 01060 PERMIT
35 '- 220 VALIDATION
DATE September 26, 1g 85 PERMIT NO. 569
APPLICANT Larry Audette ADDRESS 68 Whiteloaf Road, Southampton 021237
(NO.) (STREET) (CONTR'S LICENSE)
New Buildinp BER OF
PERMIT TO ti (_) STORY Single Family/Ati.tached Gax4 LLING UNITS 1
(TYPE OF IMPROVEMENT) NO. Lane (PROPOSED USE)
AT (LOCATION) Y PP
30 Lad sll er Lane ZONING CT SR
_
(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 construction of single family dwelling with attached garage
AREA OR 2328 sq. ft. ESTIMATED COST ,$ 127,200.00 FEEMIT s 781.00
VOLUME
(CUBIC/SQUARE FEET)
Same as Applicant
OWNER I LD I ame as ican s :Y Nf m of g
ADDRESS
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY p®RIP
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