29-360 (6) Vill. ZONING PLAN EXAMINERS NOTES
DISTRICT
FRONT YARD
SIDE YARD SIDE 1
REAR 1
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
Name Mailing address — Number, street, city, and St to ZIP code Tel. No.
Owner or
Lessee
Builder's
n
1. License No. 3C
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 ap fi-co�t Address Application date
00 NOT WRITE tBEL0W THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans By Date Plans By Notes
Fee Started Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER Is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date
Permit or Approval Check Obtained Number By Permit or Approval Check Date 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 FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued ----� �1 Lf� 19E" /
Building � Fire Grading
Permit Fee /' C
$�""-- Live Loading
Certificate of Occupancy $ Occupancy Load �
Drain Tile $ Approved by:
Plan Review Fee $ (J
TITLE
CITY OF NORTHAMPTON
�. MASSACHUSETTS
$ OFFICE of the INSPECTOR of BUILDINGS
,U, Page Plot : ' APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. 0
ZONING ,a
I• AT (LOCATION) `hr ``7"� 7,�r "'- , ��, r,G __ DISTRICT�,_,1 /F
LOCATION N0') (STREET) {
OF BETWEEN �°'°1E )•. AND
BUILDING (CROSS STREET) CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V1
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use m
m
1 ❑ New building Residential Nonresidential
2 ❑ Addition(1/ residential, enter number 12❑ One family 18 ❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13❑ Two or more family - Enter 19 ❑ Church, other religious
number of units- - - - 20 ❑� Industrial
3 Alteration (See 2 above)
14 ❑ Transient hotel, motel, 21 parking garage
4 E Repair, replacement or dormitory - Enter number
5 ❑ 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 ❑ Carport �T �, 24 ❑ Office, bank, professional
6 Moving (relocation)
❑ s ��`� � �-�E�% 25 ❑ Public utility
17 ❑� Other - Specify���� '' ''� y
7 ❑ Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP "'`"' y` I�t '' ! '�'-' — 27 ❑ Stores, mercantile
8 Private (individual, corporation, { 28 ❑ Tonks, towers
nonprofit institution, etc.) �.� /� a 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
school, secondary , e, parochial school, parking garage for,
10. Cost of improvement,,,,,,,,,,,,,,,, �G���G y school colle hl
g p p g g g
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.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS /
48. Number of stories............✓...
30 Masonry (wall bearing) 40 �❑ Public or private company
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
34 ❑ Other - Specify 42 ❑ Public or private company 50. Total land area, sq. ft. ..........
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 ❑ Gas Will there be central air 52. Outdoors........................
conditioning?
36 [� Oil L. RESIDENTIAL BUILDINGS ONLY
37 E j Electricity 44 —] Yes 45 No 53. Number of bedrooms..............
38 ❑ Coal
39❑ Other - Specify Will there be an elevator? m Full..........
- 54. Number of
46 �� Yes 47 ❑ No bathrooms
Partial........
a DEPT. I1l.DING INSPECTIONS BUILDING '°
! 212 Main Street Oa
Northampton, MA 01060 PERMIT
29 - 360 VALIDATION
DATE ..Apra l 1_4 M lN O.
APPLICANT D.J. Russell ADDRESS 74 Ya O ore
nce
(NO.) (STREET) (CONTR'S LICENSE)
OF
Alteration One Family Dwelling DWELLING UNITS
PERMIT TO 1_I STORY
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
235 Acrebrook Drive ZONING URA
AT (LOCATION) DISTRICT
(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 to screen in porch (existing) and fiberglass roof, sliding glass door
AREA OR ESTIMATED COST $ 2,000.00 FEEMIT $ 10.00
VOLUME
(CUBIC/SQUARE FEET) ^
OWNER Mr. Pease 8U1 G
ADDRESS 235 Acrebrook Drive, Florence BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY ■ PINK - ASSESSORS COPY P)NT p