29-372 (3) Vill. ZONING PLAN EXAMINERS NOTES
DISTRICT
FRONT .D
SIDE YARD SIDE • ,
REAR YARD
IX. SITE • • PLOT PLAN For Applicant
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NQT ES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants t
Name Mailing address — %'nmbcr, strcel, ci/N, ZIP code Tel. No!
1
Owner or— — — 7 E' 413 L
C' ! t' G - t'C // �)' / �L�.
Lessee
F E den's
Cad! License No.
Contractor
3.
Architect or —
Engineer
I hereby certify that the proposed work is authorized by the owner of record and that ! 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 at
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date P y lans B Date Plans By Notes
Fee Started Approved
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Approval Check Date u Approval Check Date
Permit or A um
pp Chk Number B Obtained Y Permit or A pp Number By
Y
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 a L_ 19
Building L y
Permit Fee
Certificate of Occupancy
Approve y: --�
Drain Tile
Plan Review Fee —
TITLE
o� oy
., (rzt� of Nort4ampton f f
� � �t�gs�aftlsetts
Offzrr of the 1nspertor of 'Puilbings APPLICATION FOR
ZONING PERMIT AND
Page � Plot BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: I, 11, 111, IV, and IX. p
^� r✓'" ,� _ ZONING
I• AT (LOCATION) �� (STREET)
DISTRICT
LOCATION
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
11. 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 JVAddition(If 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— — — — -->►
3 ❑ Alteration (See 2 above) 20 ❑ Industrial
14 ❑ Transient hotel, motel, 21 ❑ Parking garage
4 ❑ 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 24❑ Office, bank, professional
6 ❑ Moving (relocation) �/
❑ 17f�{ Other — Speci/y 25 ❑ Public utility
7 Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP �J �/� '. ) l'.?� 7ti '' 27 ❑ Stores, mercantile
28 ❑ Tanks, towers
BI�Prnprof (individual, corporation, 2g Other — Specify
nonprofit institution, etc.) ❑ P fY
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 $
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
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS M
30[—]Masonry (wall bearing) 40 ❑ Public or private company 48• Number of stories............
31 WWood frame 41 ❑ Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior
32FI 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
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed ....................... 0
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........
L hereby certify that the proposed work is authorized by the..owner of.record
and 1 have been authorized by the owner. to make this appl'icaiion as his
authorized agent.
x
SIGNATORE Or
ADDRESS
(NUMBER) (STREET) (clTY)
APPROVED BY TITLE
DATE 19
x
- _ DEPT. FILE COPY
Z
CITY OF NORTON BUILDING o.
NORnMPTON, MW. PERMIT VALIDATION
29 - 372
DATE September J - 19 7!z` PERMIT NO. 409
APPLICANT Hpl An Da.ni Pl ADDRESS Acra'hrook Dr.0 F`1 a•
(N0.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO (_�) STORY Mud Rn�m DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) n7�[`rP_ nok 'BriVA, ZONING �A
D tSTR ICT
(N0.) (STREET)
rn BETWEEN AND
rn
(CROSS STREET) (CROSS STREET)
a LOT
SUBDIVISION LOT BLOCK SIZE
U
O BUILDING IS 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
.� (TYPE)
O:
O REMARKS: 1inclnsc stair- to make mid room a}prox. b' X 12'
AREA OR PERMIT
VOLUME ESTIMATED COST . 600.00 FEE . to•w
(CUBIC/SQUARE FEET)
OWNER Helen 'Darnels 1
BUIL NG
ADDRESS 302 Acr_,gb ok TI-ri mp- la'lorencp BY
(Affidavit on reverse side of application to be completed by authorize gent of ownar)