32C-113 (8) 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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NOTES and Data — (For department use)
ZONING PERMITS /i
r APPLICATION 'r Map,. �p r o. Lot
Zoning Ordinance Section 10.; ecci r : File Po. Flan File '
[lam `
.).,vner �, - -- . y;1 G' _ r.-G' Applic, t '
•
c -
c-
Address J'/ A+Ires:.
Telephone -,- `-- /2 S Telephone .
This section is to be filled out in accordance ,:i t.Ii the "Table of Dittoiisionr.l and
Density Regulations: . (Z.O. AP.TICLE VI) _
Zoning Use Lot Front Depth . ti etbac'._ liax.L?ld. Min. Op.
District Itrca Width Front Side Ye; r Cover. Space ---
0/ O/
P Existing_ ��
recent Proposed % %
('lark the appropriate box to indicate the use of them parcel:
F-1 Non-Conforming Let '.,nd/or Structure. Specify.
F.,7 Residential Single F,miiily Unit Multi-Family
Duplex 0thei
L ! Business .
1 1 Industrial
Instituteor-0
1-1 Subdivision 1-1 ReL fl r I I F.U.D.
1 I Ciiiotrr L_.] Other
Subdivision with "Approval-Not-Re lti1.r ;1"--,:;tamp:
Planning 11o<ard Approval :
1 1Zoning Board Approval (Special Permit 10.9: Variance)
1 ( City Council (Special Exception S. 10.10)
I IYes rTo
',Vatershed Protection District 0verlr.y: (Z.O. Sect. -:,IV)
Parking Space Requirements: (l,.e. ,Sect. P.1) Required Proposed
Loading Space Requirements: (Z.0. sect. 8.2) Required. Proposed
Signs: (Z.0, Art. • VII) ' I Yer I 12I•o
=Environmental Performance Standards: (Z,O. Art. X1.I) 1 Iles _No_
- I
•
Plot Plan I 1 Yes I No Site Plan 1 I Yes Q No
(S. 10.2) , (S. 10.2 and 10.11
!'daiver Granted: Date 1 1
Thin: section for OFFICIAL use EEI4Lpproval as presented:
1 !Modifications necessary for approval:
I , !Return: (More information needed)
1 jDenial: Reasons:
2;0 47
i2., 4r `' ' ,,'t',� i r1,/ :..."z.,% - ` C<
Signature of Applicant -//-17 Signature of Atil(lin. Officer Date
k'
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — .A'runhcr, strrc t, rrt�, crnrl lratr ZIP code Tel. Na. _
. I /C'C' _
Owner or ��- t.� -�- ..� -o _ "� f ���?��°
Lessee ✓ �+�
Builder's
License No.
Contractor ^� q -- - —
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 applic Address Application date
11 X7
DO ' OT WRITE BE OW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Re uired Check Plan Review Date Plans B Date Plans B Notes
9 Fee Started y Approved y
BUILDING
PLUMBING S
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Obtained Number By Permit or Approval Check Obta Date
ned 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
Permit number
Building
Permit issued 19
Bui lding
Permit Fee
Certificate of Occupancy S
Approved by:
Drain Tile S
Plan Review Fee S.
TITLE
o
t) l'y,,4
QxtV. of Northampton
/R.rd ,ii- t
Iof ' it
f� Aitaseadiusetfs
CO'
--€;:.'
m� • (Mitt of the 3Ittoptrtor of lauiliiings APPLICATION FOR
Page , , .. Plot /� ZONING PERMIT AND
J
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: I, II, III, IV, and IX. Z
O
.,��_,/l ZONING �? r
7 �Yr� % r DISTRICT e"teC- ,
I. AT (LOCATION) -�y�r.�—r✓/% 1`
LOCATION (NO.) (STREET) V\
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
CI)
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D m
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use m
1 1 I New building Residential Nonresidential
2I I Addition(If residential, enter number 12 I I One family 18 I Amusement, recreational
'
of new housing units added, if any,
13 Two or more family - Enter 19 Church, other religious
in Part D, 13) number of units- - - - -�
f 20 I Industrial
3 R Alteration (See 2 above)
14 I I Transient hotel, motel, 21 I Parking garage
4 I Repair, replacement or dormitory - Enter number
5 I I Wrecking (If multifamily residential, of units
22 I Service station, repair garage
enter number of units in building in 15 I I Garage 23 Hospital, institutional
Part D, 13) 24 I Office, bank, professional
16I 1 Carport
6 I Moving (relocation)
17 I I Other - Specify 25 Public utility
7I I Foundation only
26 I School, library, other educational
B. OWNERSHIP 27 I Stores, mercantile
28 Tanks, towers
8 lXl Private (individual, corporation, I
nonprofit institution, etc.) 29 I Other - Specify
9 f 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 $ {-' school, secondary school, college, parochial school, parking garage for,
J , 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
3to; .----
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. y
G)
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS m
48. Number of stories
30 r Masonry (wall bearing) 40 Public or private company
31 5Z Wood frame 41 Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior
32 I I Structural steel dimensions r
33 I I Reinforced concrete H. TYPE OF WATER SUPPLY 4
42 Public or private company 50. Total land area, sq. ft.
34 I I Other - Specify p
43 I I Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed r
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 0
35 MI Gas Will there be central air 52. Outdoors G7
36 I I Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY ^-y \
r
37 I I Electricity 44 I Yes 4511 No 53. Number of bedrooms / (��
.
38 1 I Coal � 'j
39 I Other - Specify Will there be an elevator? Full `3
54. Number of
46 I 1 Yes 4 No bathrooms Partial
I hereby certify that the proposed work is authorized by the owner of record
and I have been authorized by the owner to make this application as his 4
authorized agent.
SIGNATURE OF AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19 .
1- DEPT. FILE COPY
Zo
BUILDING
f PERMIT
VALIDATION
4
DATE April 11, 19 77 PERMIT NO. 93
APPLICANT Chester Putraskiewicz ADDRESS 59 Conm
NO.) (STREET) (CONTR'S LICENSE)
�p
NUMBER OF
PERMIT TO Alteration-Bathroom ( $ ) STORY Rasidentjal DWELLING UNITS
(TYPE OF IMPROVEMENT) NO, (PROPOSED USE)
AT (LOCATION) 59
ConZ DISTRICT URC
(NO.) (STREET)
a BETWEEN AND
aO (CROSS STREET) (CROSS STREET)
Gs
LOT
a
m SUBDIVISION LOT BLOCK SIZE
u
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
ci
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
I (TYPE)
tt
b REMARKS: Alteration - Bathroom
AREA OR PERMIT 1Q
VOLUME ESTIMATED COST $ goo FEE Cn
(CUBIC/SQUARE FEET)
OWNER Chester Putraskiewtez BUIL• /;;f:-T
1
ADDRESS 59 Com Strant, Northampton, Man . BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)