29-221 (5) Vill. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRINT YARD
SIDE YARD SIDE YARD
IX. SITE OR •
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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 State ZIP code Tel. No.
1.
Owner or
Lessee / f
But 2. /� -C-6 o 4* try � h�' h Licenser No.
Contractor y_
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 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 By Date Plans By Notes
Fee Started Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Obttaitned Number By Permit or Approval Chec 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
II. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building• Use Group
Permit issued LLB 19 �
Building Fire Grading
Permit Fee $ '
Live Loading
Certificate of Occupancy $
Occupancy Load
Ap rov d b
Drain Tile $
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
9e t MASSACHUSETTS
• a
$ OFFICE of the INSPECTOR of BUILDINGS
Page 2!! ' Plot APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. C1
(• AT (LOCATION) ! q' Acre U[�, o D ZONING - 11 ?A
(( DISTRICT
LOCATION (NO.) STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
IL 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(If residential, enter number 12 0One family 18 ❑ Amusement, recreational
of new housing units added, if any, 13 ❑ Two or more family — Enter 19 ❑ Church, other religious
in Part D, number of units— — — —
3 ❑ Alteration (SSee e 2 above) 20 ❑ Industrial
14 ❑ Transient hotel, motel, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (11 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 Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation)
17 ❑✓ Oth c 13A J— 25 E] Public utility
7 ❑ Foundation only er — Spe iJy YUc
26❑ School, library, other educational
B. OWNERSHIP t 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 use of buildings, e.g.,. food
processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement••••,•••,••••••, s 4 3,D c) 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..................... 2" L)
9
b. Plumbing ..................... r7i1v
c. Heating, air conditioning.........
d. Other (elevator, etc.)............
11. TOTAL COST OF IMPROVEMENT 3�5z'Lt•C )
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 1V.
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?
r� L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 [_ Yes 45 No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — Specify Will there be an elevator? Full..........
— 54. Number of
46 ❑ Yes 47 ❑ No bathrooms
Partial........
�... .-�- ..�.� _..,,r_-����9� ...rm�,�.�,— �.�,�.,�.,. -�- - - - �. a _ �.. ..
+.. ...
s y DO BUILDING INSPECTIONS BUILDING Z0
212 Main Street Oa
Northampton, MA 01060 PERMIT
29 - 221 VALIDATION
DATE November 1, 19 85 PERMIT NO. 643
APPLICANT Raymond Hathaway ADDRESS 112 Ar'ra00 �V°
INO') (STREET) Q (CONTR'S LICENSE)
PERMIT TO Addition (_) STORY bathroom & dormer SUMBLLRNG UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) 112 Acrebrook Drive Z NIN cT
(NO.) (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 for the addition of a bathroom XNERX and dormer
AREA OR ! N 6 500.00 PERMIT $ 20.00
VOLUME ESTIMATED COST $ FEE
(CUBIC/SQUARE FEET)
OWNER Swie as applicant
Same as applicant's BUI DEP
ADDRESS BY TAG
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY POwl`