11A-058 (17) DEPT. FILE COPY
ciTx of NORI9NLNPTON BUILDING 3"
PERMIT DgT10N
NORTNAUMN, M. 01060
11A - $8
DATE I)C}Q11oT• '{1 19��_ PERMIT NO.
APPLICANT Ra r'1 F ^l .Ii ADDRESS !YJ Nn>•ih S},tilLn4
I�il.l IBTREEiI ILOXi P9 LICENCE(
Q9 NUMBER OF
PERMIT TO a 11.1 ROVCUEx 1 x0. l STORY RnaAdnnnmFRas a o�UCL'I -DWELLING UNITS
ZIRG
AT (LOCATION)
Hayti i RII VSTR CT 1IR&
(x0.1 (eTRCCTI
BETWEEN AND
MR... PIRLET) (1.. .1...T)
LOT
e SUBDIV(BION LOT_ BLOCK SIZE
p BUILDING IS TO BEFT. WIDE BY 96E FT. LONG BV FT. IN NEIGHT AND SHALL CONFORM IN CONSTRUCTION
P
2 TO TYPE.USE GROUP BASEMENT WALL$ OR FOUNDATION
E (T"o
0
li REMARKS: p (� p
VOLUME OR ESTIMATED COST p_ 3��-�.-�.nn FEEMIT y go-nn
VOLUME
ILVLIC/CUUML YCL}1
OWNER Mule..--kt
ADDRESS 192 NN rhh Et t+ n1 Rt N N.F�ttOy BY
(Affidavit Pn rovaPa SWO of aPPkIlitbm tR br GamPI by autbonzed agsnf Of ownBT)
I hereby certify that the p'r"opatel.work is authorized by tha owner of-record
and I have been wthoriied by the owner to make thi;,-gpoil c (on ,af his
authorized agent.
SIGNATURE 41--AG€'NTV . ( - .. '' .. • _ a::5i.
ADDRESS
(NUMBER) (STREET) -' - - (CITY)--
'
APPRQYED BY TITJ.E
DATE 19 .
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Office of tilt Inspector Of 'PailhingsPPL CATION FOR
ZONING PERMIT AND
Page_Z)_'A_ PlotBUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. p
I. AT (LOCATION) � �L n/d/' D L'•1r n15TnICT�' L,(
LOCATION
OF BETWEEN 1a ti 5TREETI AND
BUILDING Ice°ss t—II117
LOT
S V6V IV IS IOH LOT BLOCN SIyZE
N
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D s
m
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"wrecking" most recent use m
1�zl New building Residential Nonresidential
2 ❑ Addition(if resido"iial, enter nronber 12� One 1..111 16 ❑ Amusement, retread anal
o/ nem bousinq units added, i/anY. 13 Two or more faml It — Enter 19 ❑ Church, other religions
in Part D, ]3) number o/units— — — — y_ 20❑ Industrial
3 ❑ Alteration (See 2 above) 14❑ Tronuem howl, motel, 21 ❑ Parking garage
4❑ Repair, replacement or dormitory — Enter number
5❑ Wrecking fl/multifamily residential, o/ units —--———— — —i— ❑ Service station, repair garage
enter number o/units in building in 15'X Got... 23❑ Hospital, instimticnal
Part D, 131 I6 ❑ Carport 24 ❑ Office book, prof.,si omeI
6❑ Moving (relocation) 1TS Other — 25❑ Public utility
T ❑ Foundation only ❑ pacify
26 ❑ School, library, oche.educational I
B. OWNERSHIP Z'❑ Stores, mercantile
8 Private(individual, corporation,Non,
2B ❑ Tanks,Powers
nonprofit institution,etc.) 29❑ Other — Specify
9 ❑ Public (Federol, Stare, or
I.cal government)
C. COST (Omit cents) N.nmsidenti.l — Describe in detail Prop...d use of bui ld i ms, e.g., food
Sorb 60 processing plaint, machine shop, loundry building at hospital, elementary
10. Cost of improvement................ school, secondary school, college, parochial school, parking going&for, ,
department Bron, .ental office building, office building of industrial plant.
To be installed but not included II use of es sting building Is being changed,enter proposed use.
th
in e above cos( �—Xc�9 /
a.n bec,tical.......................
It. Plumbing ......................
e. Hearing, aU condirianing......... :52
d.Other(clever.,, etc.).............
11. TOTAL COST OF IMPROVEMENT S 3G '000
111. 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. y
E. PRINCIPAL TYPE OF FRAME G. TYPE
I OF SEWAGE DISPOSAL 1. DIMENSIONS G)
30 F]Masonry (wall bearin ) 40,1&Public or 48. Number of star es..............
g Private company 49 Tal leer of floor no,
31� Wood frame 41 ElPrivate(septic link,.1c.) all flon ..Ante
o
oors, based on..roti or
32❑ Structural steel dimensions ............
33 ❑ Reinf.rced wont,. H, TYPE OF WATER SUPPLY
34❑ Other — Specify 42❑ Public or private company 50. Total land Area, sq. if. ...........
43 Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ........I........�... r
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35❑ Gas WIII there be umril it 52. Outdoor....................... L
conditioning?
36 011 L. RESIDENTIAL BUILDINGS ONLY '
37 Electricity 44❑ Yee 45,Q No 53. Number of bedrooms.............. ` 1
30❑ Coal
39❑ Other— Specify WIII there be an elevator? 1 Full AAAA.. .
46Y., 4T%C No Pmtial.
54. Number of 1(`
❑ bathrooms
..�.
IV. IDENTIFICATION — To be completed by all applicants
Nome Mailing oddrers = % _ _ ZIP code Tel No
Do
Leasee
Connoer..
I hereby certify that the proposed work Is authorized by the cwi A al record z,a. I'nor I hove been aclhor,zed 6y the owner to
make this app 1.cutloa as hIs authorized agent and we ogres to to�rfonn to all applicable laws of this luI, dlCtior
Signature of applicant Address Applcarlon dme
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plm Rev— Dore Pions Dot, Ploos
Plana Review Required Chock Fee Smrred By q d BY No,,,
BUILDING S
PLUMBING
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Obtained Number By Permit or Are....f Check Obra-ed Nambor 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 � � --yy��
Permit Issued 414- 19 —'—
Building
Permit Fee $ ,sii
Certificate cf Occupancy S
Approved by:
Drain Tile S
Plan Review Fee S—
T
CITY OF NORTHAMPTON °:
Tax Map No. " Lot ,'�—
ZONING PERMIT APPLICATION i e
Zoning Ordinance Section 10.2 Received: File No. Plan File
Owner Applicant
Address Address
Telephone Telephone —
This section is to be filled out in accordance with the 'Table of Dimensional and Density Regulations:
(Z.O. ARTICLE VI)
Zoning Use jArea
FrontDepthSetbacks Max. Bid. Min. Op.
District Width Front Side Rear Cover Space
Past / ,D Existing %
PreseVtr' Proposed n
Mark the appropriate box to indicate the use of the parcel:
Non-Conforming Lot and/or Structure. Specify
,Residential Single Family Unit ❑Multi-Family
❑ Duplex ❑ Other
.Business
❑ Individual
❑ Institutional
C Subdivision El Regular ❑ P.U.D.
❑ Cluster ❑ Other
❑ Subdivision with "Approval-Not-Required"-Stamp:
C Planning Board Approval:
C Zoning Board Approval (Special Permit 10.9: Variance)
❑ City Council (Special Exception S. 10.10)
Watershed Protection District Overlay: (Z.O. Sect. XIV) ❑ Yes No
Parking Space Requirements: (Z.O. Sect.8.1) Required Proposed '2---
LoadingSpace Requirements: (Z.O. Sect.8.2) Required Proposed
Signs: (Z.O. Art. VII) ❑ Yes No
Environmental Performance Standards: (Z.O. Art. XII) ❑ Yes XNo
Plot Plan Yes EJ No Site Plan El Yes El No
(S. 10.2) (S. 10.2 and 10.11
Waiver Granted: Date ❑
- - - - - - - - - - - - - - - -- -- - - - - - - - - - - - - -- --- - ---
This section for OFFICIAL use only:
////1 Approval as presented:
El Modifications necessary for approval:
❑ Return: (More information needed)
❑ Denial: Reasons:
o �, — oma? '_
Signature of Applicant Date Sig ture dmin. Offic Date
e...-.....^.Sn
NOTES and Dam — (For depanmen� use)
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