29-132 (5) Vill. ZONING PLAN EXAMINERS NOTES
DISTRICT
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
IX. SITE OR PLOT PLAN For Applicant Use
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NOTES and Data — (For deportment use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, stmt, city, and State ZIP code Tel. No.
Owner or
Lessee !
Builder's
2.
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.
�ature of applicant Address �-- Application date
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Re uired Check Plan Review Date Plans By Date Plans B Notes
q Fee Started Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Do
Permit or Approval Check Obtained Number By Permit or Approval Check Obttaitned 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
Bui(ding. / Use Group
Permit issued ! 19
Building Fire Grading
Permit Fee $
Live Loading
Certificate of Occupancy $ Occupancy Load
Drain Tile $ Appr
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
9$ MASSACHUSETTS
OFFICE of the INSPECTOR of BUILDINGS
� C
WT Page- Plot 2:a APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
/o ZONING
I• AT (LOCATION) �-' -l�f-�I r/�I '� DISTRIC
LOCATION �� (N0.) (STREET)
OF BETWEEN Xy0 p 11 Z/9 !� dd AND / L'tC4_ A/ L G
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
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(It residential, enter number 12 ❑ One family 18 E] 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 ❑ 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 F-1 Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation) p
17 ❑ Other — Specify feT�L'"� 25 ❑ Public utility
7 ❑ Foundation only //�� 26 ❑ School, library, other educational
B. OWNERSHIP .diw Kl 27 ❑ Stores, mercantile
6 ❑ 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 propo d use.
in the above cost
a. Electrical..................... O X
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
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
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 .......................
35 ❑ Gas Will there be central air 52. Outdoors........................
36 ❑ Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 j Electricity 44 5 �I No
❑ Yes 4 �--- 53. Number of bedrooms.... .......
38 ❑ Coal
39 Other — S c ci Will there be an elevator?
�_� 1 fy F . ......
54. Number of ull..
46 ❑ Yes 47 ❑ No bathrooms l!
Partial........
Department of Buii _jnspections I
212 Main Street zQ /Z) ,
Northampton Mass. 01060 BUILDING �-
PERMIT
29 - 132 VALIDATION
DATE_ July 18, 19 84 PERMIT NO. 310
APPLICANT Dorothy Dushane ADDRESS 26 Gold ea_ Fl aren e _Lfnner
(NO.) n TRr
(CONTR'S LICENSE)
OF
Alteration Screened in Deck DWELLR
PERMIT TO STORY
DWELLING NUMBER -
- STORY
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
U�
26 Golden Drive ZONING
AT (LOCATION) Florence DISTRICT y�
(N0.) (STREET) s
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
Deck
G IS TO BE 10 FT. WIDE BY 12 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(Tree)
REMARKS. permit to screen in existing 10'-x 12' deck in the rear of__existing r1wP11;ng
AREA OR 120 Sq. ft. ESTIMATED COST .� 200.00 fEEM'T 10.0
VOLUME
(CUBIC/SQUARE FEET) ��/,o
OWNER Wibert & Dorolby Dushane 1)CIA,:
ADDRESS 26 Golden Drive, Florence, Masi 01060 BY-
WHITE
- FILE COPY ■ GREEN - FIELD COPY ■ CANARY - APPLICANT COPY PINK - ASSESSORS COPY