29-349 (5) ZONING
DISTRICT
- '
USE
FRONT YARD
SIDE 1 SIDE r
REAR YARD
NOTES
IX. SITE OR PLOT PLAN For Applicant
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — .A'urnbcr, strccl, rifN, carer/ State ZIP code Tel. No.
—3 2 tilt
Owner or
Lessee
Builder's
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 2oflicant Address Application date
r
C J L"O
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans B Notes
9 Fee Started y Approved y
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date
Permit or Approval Check Obtai ed 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 19�
Building ��� P G
Permit Fee $ —�
Certificate of Occupancy S
Approved by:
Drain Tilea
Plan Review Fee S—
n
TI
$ �Glssacllicsetfs
71'
Offire of the �ns}lertor of 'Auilbings u.
APPLICATION FOR
ZONING PERMIT AND
Page �Plot BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. p
..- /.,q] � ZONING �j1
I• AT (LOCATION) r�r' 1 u f\fCj (.I !z f �"• DISTRICPr
LOCATION (NO.) (STREET
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
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
❑ 12 One family 18 ❑ Amusement, recreational
of new housing units added, if any, 13 ❑ Two or more fomily - Enter 19 ❑ Church, other religious
Flu in Part D, 13) number of units- - - - -� 20❑ Industrial
3 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 1 23 ❑ Hospital, institutional
Part D, 13) 16 Carport 24❑ Office, bank, professional
"
6 ❑ Moving (relocation) 7
17 Other - SpeciJy 25❑ Public utility
7 ❑ Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8X 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..................... v rZ `
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,V. y
0
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS r'-1 m
30❑ Masonry (wall bearing) 40 ❑ Public or private company 48. Number of stories........ .
49. Total square feet of floor area,
31 ❑ Wood frame 41 ❑ Private (septic tank, etc.) all floors, based on exterior
32❑ Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
50. Total land area, sq. ft. ...........
34 F__1 42 Other - SpeciJy ❑ Public or private company
p y
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ....................... 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 ❑ No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other - Specify Will there be an elevator? 54. Number of Full..........
46 ❑ Yes 47 ❑ 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
authorized agent.
SIGNATURE 'OF AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
i
F- DEPT. FILE COPY
CITY OF NORTHMTON
BUILDING
Dr
NORTHAMPTON, MASS. MIT VALIDATION
29 -
DATE_ September 9, 19-2 PERMIT NO. ?aril
APPLICANT Mrs. Ginette TomasauckaS ADDRESS 56 Austin Circle. Flo.
(NO.) (STREET) (CONTR"S LICENSE)
NUMBER OF
PERMIT TO Add Chimney (,) STORY For Mood Stove DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 56 Ausati n (':irt la D STR CT VGA
(NO.) (STREET)
m BETWEEN AND
a
(CROSS STREET) .(CROSS STREET)
n SUBDIVISION LOT BLOCK SIO E
m
a
v
O BUILDING 1S TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
f
� (TYPE)
� REMARKS: _— f�K� ^ �fiYl @'f off' wood =±w.re
AREA OR PERMIT
VOLUME ESTIMATED COST $ 200-00 FEE $1-O
(CUBIC/SQUARE FEET) 4aggent OWNER Raymond TomasaUnkas ^BUILDI G D P ADDRESS Austi n_Circle- r3 orence BY
(Affidavit on reverse side of application to be completed by out ed of owner)