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VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD -
ARD 1 - - ) YARD
REAR YARD
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NOTES
IX. SITE OR PLOT PLAN — For Applicant Use
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
�Naamme /I/4 I Mailing address — � N s umber, street, city, and State ZIP code Tel. No. �
Ow ner or / �"J C /L l,� d (�7` ' 7'2 3 / / +=i C. e/C C_ / ,67
.l O�' ✓ 2 j
Lessee
Builder's
2.
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.
4Signaturti of appl'cont � �r Address Application date
DO NOT WRITE BELOW THIS LINE
. V. PLAN REVIEW RECORD — For office use
Plans Review Required Check
Plan Review Dote Plans By Date Plans By Notes
9 Fee By Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date
Permit or Approva 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 7
Permit number >�.1 (� I FOR DEPARTMENT USE ONLY
1
Building Use Group
Permit issued S'S C 19 �
Building ,,,,) Fire Grading
Permit Fee $ fa •t�C/ Live Loading
Certificate of Occupancy $ Occupancy Load
Ap ed by:
Drain Tile $ r �
Plan Review Fee $
TITLE
. ,r CITY OF NORTHAMPTON
MASSACHUSETTS
A .Q ems= 'i
,, ''q
_�.J, r
; '.a OFFI of the INSPECTOR of BUILDINGS
A(., _ t
' cZvfr" I
,Z ,.e .,_.� Pa ( Plot —j APPLICATION FOR
ZONING PERMIT AND
INSPECTOR
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, Ill, IV, and IX. 0
ZONING
s ' '� F .-e = /Cc/
I. AT (LOCATION) C% DISTRICT, 4
LOCATION (N0.) (STREET) � ' T
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
xl
A. TYPE OF IMPROVEMENT D. PROPOSED USE – For "Wrecking" most recent use m
m
1 I 1 jp..v building Residential Nonresidential
2 Addition(1/ residential, enter number 12 ne fomi ly 18 1 1 Amusement, recreational
of new housing units added, if any,
in Part D. 13) 13 I 1 Two or more family – Enter 19 L_J Church, other religious
number of units– – – – --> 20 Li Industrial
3 1 Alteration (See 2 above)
14 I Transient hotel, motel, 21 C� Parking garage
4 I I Repair, replacement or dormitory – Enter number
5 1 1 Wrecking (1l multifamily residential, of units – --.)- 22 ❑ Service station, repair garage
enter number of units in building in 15 I Garage 23 [J Hospital, institutional
Part D, 13)
16 I Carport 24I Office, bank, professional
6 Moving (relocation)
17 I - I Qter – Specify 25 LA Public utility
7I 1 Foundation only
26 1 School, library, other educational „--,,,i.„,
B. OWNERSHIP �� L.. r �'. _ i .....4 1 27I Stores, mercantile
8 I I Private (individual, corporation, 28 1 1 Tonks, towers
nonprofit institution, etc.) 29 Li Other – Specify
9 1 I 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 $ / e s Du 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 /61 y /6 /)e.'C
/�
b. Plumbing j r lC
a I( 9 " -.) c. i.
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
48.
30 I 1 Masonry (wall bearing) 40 LJ Public or private company Number of stories
_
31 1 1 Wood frame 41 I_J Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior
32 I 1 Structural steel dimensions
33 I 1 Reinforced concrete H. TYPE OF WATER SUPPLY
34 I Other – Specify 42 1 Public or private company 50. Total land area, sq. ft. —
43 17 Private (well, cistern) K. NUMBER OF OFF- STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed
35 1 1 Gas Will there be central air 52. Outdoors
36 LA Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 p j Electricity 44 I I Yes --1 --1 No
53. Number of bedrooms
381 Coal
39 L 1 Other – Specify Will there be on elevators Full
54. N umber of
46 [ 1 Yes 47 b ___1 No bathrooms
Partial
_}, DEIsT O F BUILDING INSPECTIONS BUILDING � o D � /�
�` `„ 212 Main Street Northampton, MA 01060 PERMIT o a 1 � �._ ..1
4
37 - 10 VALIDATION
DATE Amp 1 6 LJ y+j�QQ�( P R M I N o. 161
APPLICANT Robert A . Martula ADDRESS
0 F1Urence Road uwner
(NO.) (STREET) (CONTR'S LICENSE)
Addition One Family NUMBER OF
PERMIT TO (_) STORY ✓ DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE) C
AT (LOCATION) 623 Florence Road ZONING
CT SR
(N0.) (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 10' X 16' deck and a 16' X 4' porch
AREA VOLU ESTIMATED COST $ 1,000.00 aril- 10 00
(CUBIC /SQUARE FEET)
OWNER Same as Applicant
(
IL 64442..11... ADDRESS. Same as Applicant's BY F 7iT
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY pjNT p