18C-104 (3) 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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PINT II P
NOTES and Data — (For department use)
I
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address - Number, street, city, and State ZIP code Tel. No. _
1 0 . wner or
Lessee /
N A, L icense No. �
2. - SV, •.G� Pig'," r:4I6 :a 4ioc G 355 F GS]�- '`) Builder's 3
3. �` E!a
Contractor /tic c TA, 6-0.5 �`.'. V
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.
Si nature of applicant Address Application date
410 01C/ DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans By Date Plans By Notes
Q Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date
Permit or Approva I 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 q-1(31 FOR DEPARTMENT USE ONLY
Permit number
Building(' Use Group
Permit issued C}:S / 19 J
Building Fire Grading
Permit Fee $ "Co Live Loading
Certificate of Occupancy $ �'`' Oc upancy Load
Approve
Drain Tile $ / „i j "
Plan Review Fee $ / I,
TITLE
^^ - CITY OF NORTHAMPTON
MASSACHUSETTS
-1`.....■ •• �t►ra : OFFICE of th INSPECTOR of BUI DINGS
J i=1.4.4'
1
�vf Mme.,
�,��, P age Plot APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT - Applicant to complete
�l l 7 ete all items in sections: I, II, Ill, IV, and IX. 0
j 9 f / t Q �� ZONING
I. AT (LOCATION) f ��C�' .�C!'✓ T-C` C f r' DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN Q f t e-e- 5 ems- AND
BUILDING { (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
VI
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D —4
7)
A. TYPE OF IMPROVEMENT D. PROPOSED USE – For "Wrecking" most recent use m
M
1 I ] New building Residential Nonresidential
2 Addition (If residential, enter number 12 cl,. One family 18 Li Amusement, recreational
of new housing units added, if any,
in Part D 13) 13 Two or more family – Enter 19 L i Churc , other religious
number of units– – – – --0- 20 Li I ustrial
3 U Alteration (See 2 above)
14 Ci Transient hotel, motel, 21 [ Parking garoge
4 Li Repair, replacement or dormitory – Enter number
I
5 L _J Wrecking (If multifamily residential, of units — 22 _ -] S ervice station, repair garage
enter number of units in building in 15 (( I Garage 23 [1 H ospital, institutional
Part D, ]3 )
9 16 II Carport 24 i O ffice, bank, professional
6 n Moving (relocation)
7 Li Foundation only 17 L] Other – Specify 25 [7] Public utility
26 C School, library, other educational
B. OWNERSHIP 27 i Stores, mercantile
8 Private (individual, corporation, 28 Tanks, towers
nonprofit institution, etc.) 29 i J Other – Specify
9 Li 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 $ 7SOC school, secondary school, college, parochial school, parking garoge 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, en r proposed use.
in the above cost !
a. Electrical Ay 0 ,t,.I,, (. /}� '>,(�; ,e. y+ y'i n01 ,{,/Vy / _ ., 4J
b. Plumbing j ,
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
30 Masonry (wall bearing) 40 Public or private company Number of stories
31 Wood frame 41 1 Private (septic tank, etc•) 49. Total square feet of floor area,
all floors, based on exterior
32 I I Structural steel dimensions
33I I Reinforced concrete H. TYPE OF WATER SUPPLY
34 I I Other – Specify 42 Xi Public or private company 50. Total land area, sq. ft. —
43 I i Private (well, cistern) K. NUMBER OF OFF- STREET
PARKING SPACES
51. Enclosed
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 I I Gas Will there be central air 52. Outdoors
36 Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 L _ j Electricity 44 f 1 Yes 45 IIIII No 53. Number of bedrooms 92,
38 Li Coal
39 L1 Other — Specify Will there be an elevator"' Full
}}} 54. Number of
46 I I Yes 47 No bathrooms
Partial
-.}},,' DEPT. OF BUILDING INSPECTIONS
212 Main Street BUILDING z_
o a •i .
j > >�i
y> Northampton, MA 01060 PERMIT a
18C - 104 VALIDATION
DATE July 2c, 19 RR PERMIT NO. 472
APPLICANT cundance Design ADDRESS 355 Bride St_ 005553
(NO.) (S EET) (CONTR'S LICENSE)
PERMIT TO , n(f (j j 1 j (fin ( STORY One Family D
WELLING NG UNITS
(TYP P ENT) NO. (PROPOSED USE)
49 Gleason Road ZONING URB
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 dormer onto one family dwelling (2 bedrooms & bath)
AREA OR 828 sq � ft ESTIMATED COST $ 7,500.00 FEE
$ 32.00
VOLUME
(CUBIC /SQUARE FEET)
OWNER Eben Moodie s�
49 Gleason Road BUILDING • �� ` `
ADDRESS BY
WHITE - FILE COPY • GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY
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