29-341 (6) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
IX, SITE OR
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NOTES and Data — (For department use)
lo
IV. IDENTIFICATION To be completed by all applicants
Name Mailing address \'umber, sfrcct, (-11\, (I'l'i Slatc, ZIP code Tel. No.
Ax r
O�ner or
Lessee
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
c le
DO N 0 T WR | TE BEL0 W TH | S L | NE
V. PLAN REVIEW RECORD — For office use
Plan Review Date,Plans By Date Plans By Notes
Plans Review Required Check Fee Sta ted Approved
BUILDING $
PLUMBING
MECHANICAL
ELECTRICAL
OTHER I$
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
Permit number
Building
Permit issued 2xx e, 3,9 19
Building 1�
Drain Tile
Plan Review Fee
TITLE
. , per ro
Crit� of 'Nartha tptan
� � ,l�Ixssaclprsetfs
Office of the �naptrtor of Nuilbings
APPLICATION FOR
Page Plot ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in /sections: 1, 11, 111, IV, and IX. p
J''
(. t. fti.. DISTRICT(,
AT (LOCATION) i 1 `
LOCATION (NO.) (STREET)
OF BETWEEN t' �. 7:-C1J�'i:.>, .ld _AND K r
BUILDING GROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
y
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 ❑ New building Residential Nonresidential
2 Addition(! residential, enter number
J 12 One family 18 ❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 F Two or more family — Enter 19 ❑ Church, other religious
number of units— — — — --)� 20❑ Industrial
3 ❑x Alteration (See 2 above)
14 ❑ Transient hotel, motel, 21 ❑ parking garage
4 Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (If multifamily residential, of units ——————— — -� 22 Service station, repair garage
enter number of units in building in 15❑ Garage 23 Hospital, institutional
Part D, 13)
16 Car 24❑ Office, bank, professional
6 ❑ Moving (relocation) ❑ p ort
' !f i Public utility
7 ❑ Foundation only 17 F-1 Other — Specify / �' 25❑
26 ❑ School, library, other educational
B. OWNERSHIP f'; d >' t'" 27 ❑ Stores, mercantile
8 Private (individual, corporation, 28 ❑ Tanks, towers
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,,,,,,,,,,,,,,,,
? 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 $ z, '
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
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS O
m
?c>
30❑ Masonry (wall bearing) 40 Public or private company 48. Number of stories................
31 Wood frame 41 ❑ Private (septic tank, etc.) 49• Total square feet of floor area,
all floors, based on exterior
32❑ Structural steel dimensions .....................
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY i
50. Total land area, sq. fT. ...........
34 F-1 Other — Specify 42 [�] Public or private company
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ....................... >'t?'' r
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL O
35❑ Gas Will there be central air 52. Outdoors........................
36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 ❑ Yes 45 LJ No 53. Number of bedrooms..............
38 Coal
39❑ Other — Specify Will there be an elevator? 54. Number of Full.......... d
46 ❑ Yes 47[5�fNo 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.
authorized agent.
SIGNATURE OF' AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
KK
t,<
APPROVED BY TITLE
DATE 19
Z
DEPT. FILE COPY
ate•-,., 4
CITY OF NORTHAMPTON BUILDING f a
PERMIT VALIDATION
NORTHAMPTON, MASS. 29-341
DATE December 30, 19 77 PERMIT NO. 598
APPLICANT Mari a7we Berl i n ADDRESS
(N0.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO C'onstmet Chimney —( 1 ) STORY For Wood burniIg stove DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 118 Austin CHrele, jprtha m DISTRICT
(NO.) ISTREET)
w BETWEEN Ari ra_ =C2d + .roa t AND Pcrnarnl �i'�.
'o (CROSS STREET) (CROSS STREET)
w
LOT
CL SUBDIVISION LOT BLOCK SIZE
m
U BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
m
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
o REMARKS:COR811nn1 Ohi=n Y fOr WQ0d bMXMi li' At0Ve
AREA OR PERMIT
VOLUME ESTIMATED COST $ 3.W..nn FEE �n.n0
(CUBfC/SQUARE FEET) �f
OWNER ,Marimu3e Berlin �I
BU D T
ADDRESS i iS Ana tin Cirel e, Fl_arF nce - B
(Affidavit on reverse side of application to be completed by authorized age of owner)