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DISTRICT
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REAR YARD
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NOTES and Data — (For deportment use)
t
IV. IDENTIFICATION — To be completed by all applicants
Nome Mailing address — Number, strcct, rich, anr/ .Statc ZIP code Tel. No.
v` Owner or
Lessee
Builder's
2. License No.
Contractor 7
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.
$ignaiure of applicant Address Application date
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 Obta ned Number By Permit or Approval Check 0btta 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 3
Permit number
Building
Permit issued r� 19
Building
Permit Fee $
Certificate of Occupancy S
Approved by:
Drain Tile
Plan Review Fee S_ 1
� TI LE
o� ro
� � �Ixss�lclptsetfs
t` Offire of the , navertor of 'Puilbings
APPLICATION FOR
ZONING PERMIT AND
Page Plot BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. Z
O
ZONING
I• SAT (LOCATION) ;' DISTRICT
LOCATION (NO.) (STREET)
OF .BETWEEN µ AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
II, TYPE AND COST OF BUILDING — All applicants complete Parts A — D 7�0
M
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use M
--I
1 ❑ New building Residential Nonresidential
2 ❑ Addition(If residential, enter number 12❑ One family 18 ❑ 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 ❑ Industrial
3 Alteration (See 2 above) V
14 ❑ Transient hotel, morel, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
5 El 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 24❑ Office, bank, professional
6 ❑ Moving (relocation) F
17 ❑ Other — Specify`"" 25 ❑ Public utility
7 ❑ Foundation only s
26❑ School, library, other educational
B. OWNERSHIP 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 u;e of buildings, e.g., food A
processing plant, machine shop, laundry building at�gspitol, elementary 114t
10. Cost of improvement,,,,,,,,,,,,,,,, school, secondary school, college, parochial school`parking garage for,
school, store, rental office building, office building,ai 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 m
30 lvlasonry (wall bearing) 40 ❑ Public or private company 48• Number of stories..............
31 ❑ Wood frame 41 ❑ Private (septic tank, etc.) 49. Total square feet 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 F❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. .CIPA-L TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL F. Enclosed ....................... O
P * Will there be central air L. Outdoors........................ �
36❑0 wq conditioning?
. RESIDENTIAL BUILDINGS ONLY
37❑ Ele !Ally °' 44❑ Yes 45 No U
❑ 53. Number of bedrooms..............
38 ❑ Coal
39❑ Other — Specify Will there be an elevator? 54. Number of Fu)I..........
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 appli Ceti on 4s-:<Ws :'
authorized agent.
SIGNATURE OP AGENT ".
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY _. w., .. TITLE
DATE l9
DEPT. FILE COPY
Z
CITY OF NORTHAMPTON BUILDING a a
PERMIT VALIDATION
29 - 359
DATE September 28, 19 72 PERMIT NO. 4913
APPLICANT___Maureen Novotny ADDRESS 2�1 Aprebb�Ak five
(N0,) (STREET) (CONTR'S LICENSE)
PERMIT TO Add chimtte ( ) STORY NUMBER OF
(TYPE OF IMPR VEMENT) N0. F�r (PROPOSED DWELLING UNITS
AT (LOCATION) 2 51 ACrAbrOak Drive ZONING
isFe1�
(N0.) (STREET) D STN CT
a BETWEEN Austin Circle AND Austin (*jirelA
(CROSS STREET) - (CROSS STREET)
m
B LOT
m SUBDIVISION LOT BLOCK SIZE
a
V
m BUILDING IS TO BE FT, WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
Z TO TYPE USE GROUP_ BASEMENT WALLS OR FOUNDATION
� (TYPE)
IL REMARKS: Add chi mnlAy f= WAXW 13 oye
AREA OR VOLUME ESTIMATED COST $ 2 }( FEEMtT
(CUBIC/SQUARE FEET) $
I
OWNER
BUILD14
!,'o DEP
ADDRESS BY
(Affidavit on reverse side of application to be completed by out o e agent of owner)