29-327 (8) VIII. ZONING PLAN EXAMINERS NOTES
FRONT DISTRICT
SIDE YARD SIDE YARD
REAR YARD
1 NOTES
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NOTES and Data — (For deportment use)
IV. IDENTIFICATION — To be completed by all applicants
��.-�nn Name Mailing address .Cumber, strc�c°t, cith, rml Stcuc° ZIP code Tel. No.
Owner or " C t -�/V I� 0(f y�
Lessee
Builder's
L. I 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.
Signature of applicant Address Application date
livow, n ,,A a I±h (2 4 Y-7�
D0 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plan Review Date Plans Date Plans
Plans Review Required Check Fee Started By Approved BY Notes
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
ate Date
Permit or Approval Check ObDtained 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
Permit number .3
Building
Permit issued 19--;1 _
Building
Permit Fee $ r/
Certificate of Occupancy S
Ap ov by:
Drain Tile
Plan Review Fee _ /
t
TITLE
• Teti
Crzty of Nort4auipton 4F(3g`
�I MSSMCJ)1tSfttB
T offire of the �nspicrtor of 'Puilaiugs APPLICATION FOR
J 7 ZONING PERMIT AND
Page Plot BUILDING PERMIT
z
IMPORTANT — Applicant to/`��co►mpplet`te all items in sections: I, 11, 111, IV, and IX. O
I. 0S /tLJ 5- LJrr'C K � Fyv (� ZONING
AT (LOCATION) DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
III. 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 F-1 New bldg 1 Residential Nonresidential
2F-1 Addition(If residential, enter number 12� One family 18 D Amusement, recreational
of new bousing units added, if any,
in Part D, 13) 13 Two or more family - Enter 19 Church, other religious
number of units- - - - -- 20 F-1 Industrial
3 [IF1 Alteration (See 2 above) 14E] Transient hotel, motel,
21 Parking garage
40 Repair, replacement or dormitory - Enter number
50 Wrecking (If multifamily residential,
of units ------- - -i 22 ❑ Service station, repair garage
enter number of units in building in 15 � Garage 23 Hospital, institutional
Part D, 13) 16 F__] Carport 24 Office, bank, professional
(
6 D Moving (relocation) 17 [:] Other - Specify 25 Public utility
7E] Foundation only 26 School, library, other educational
B. OWNERSHIP C VN i r 1i 27 Stores, mercantile
4�V\ 28 Tanks, towers
8 D Private (individual, corporation,
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................ V' 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.....................
b. Plumbing .....................
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. D
O
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE: DISPOSAL J. DIMENSIONS 111
48. Number of stories...............
30 D Masonry (wall bearing) 400 Public or private company
41 D Private (septic tank, etc.) 49. Total square feet of floor area,
31 Wood frame an all floors, based on exterior
32 F-] Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
50. Total land area, sq. ft. ...........
34 F--] Other - Specify 42 Public or private company
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES .D
51. Enclosed ....................... O
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 0
35 D Gas Will there be central air 52. Outdoors........................
36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 D Yes 45 D No 53. Number of bedrooms..............
38 Coal
39 Other - Specify Will there be an elevator? Full..........
54. Number of
46 D Yes bathrooms
47 � No 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,aopl i.catiow.,os his
authorized agent.
SICNATURIE OF _AGENT'
ADDRESS.
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19 -
DEPT. PILE COPY
ZD
CITY OF NORTHAMPTON BUILDING a IL
NORTHUWMN, XM. PERMIT VALIDATION
29-327
DATE August 24, 19- 7 PERMIT NO. 384
APPLICANT Rnnald J. Na111f ADDRESS 30A At-ra reink Dr.. Flo,
pry,;,,,,„ (N0.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Add�imne� {_) STORY' C e ► DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) ,308 Acrebrook I2rive, Florence DISTRICT U
(NO.) (STREET)
rn BETWEEN AND
'0 (CR033 STREET) (CROSS STREET)
O
a LOT
m SUBDIVISION LOT BLOCK SIZE
a
V
O BUILDING IS TO BE-FT. WIDE BY - FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
¢I
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
f (TYPE)
0 REMARKS: Add Chi mney
AREA OR PERMIT
VOLUME ESTIMATED COST $ 49,,nn FEE 0—(14
(CU81C/SQUARE FEET)
OWNER Rongld .T. Xa,,J+
ADDRESS 348 Acrebrook Drive, Florence a LD
(Affidavit on reverse side of application to be completed by authorized a nt of owner)