29-208 (3) V111. ZONING PLAN EXAMINERS NOTES
DISTRICT
FRONT YARD
SIDE YARD
SIDE YARD-" ZL
REAR 1
NOTES
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NOTES and Data — (For department use)
i
II F
R
I
— - - - —-,----- ----
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IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, City, a77ri State ZIP code Tel. No.
1,
Owner or (r�.�irlf_ !,_ IIL y / ��at I].':a -I( fZ<,•ir t.
Lessee
Builder's
Contractor License No.
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 Pions B Date Plans g Notes
Fee Started Y Approved Y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL Is
OTHER Is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number B Permit or Approval Check Date umber B
Obtained Y pp Number 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 FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued 19
Building Fire Grading
Permit Fee $ Zfi �)� Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
g. .� MASSACHUSETTS
OFFICE of the INSPECTOR of BUILDINGS
Page Plot 4 APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
,C� ZONING
DISTRICT
it �s
I. AT (LOCATION) /� {_,� r�' �:E Y Ic
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
t/t
II. 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
21V Addition(if residential, enter number 12 One family 18 ❑ Amusement, recreational
of new bousing units added, if any. 13 Two or more family — Enter 19 ❑ Church, other religious
in Part D, 13)
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 (1/multifamily residential,
of units ——————— — -- 22 �7 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) 25 ❑� Public utility
17 ��] Other — Specify
7 Foundation only 26 ❑ School, library, other educational
B. OWNERSHIP L, h 27 Stores, mercantile
28 ❑ Tanks, towers
8 N Private (individual, corporation,
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 proposed use.
in the above cost
a. Electrical......
b. Plumbing .................... ��/T
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
41 �� Private (septic tank, etc.) 49• Total square feet of floor area,
31 Wood frame P all floors, based on exterior
32❑ Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
50. Total land area, sq. ft. ...........
34 ❑ Other — Specify 42 ❑ Public or private company
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........................
36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 E7J Electricity 44 ❑ Yes 45 ! No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — Specify Will there be an elevators 54. Number of Full..........
bathrooms
46 1 Yes 47 No Partial........
MINNOW
DEPT. OF BUILDING INSPECTIONS BUILDING Z°
212 Main Street 04
I IL
Northampton, MA 01060 PERMIT
11" 29 - 208 VALIDATION
DATE July 27, 19 87 PERMIT NO. 492
APPLICANT Mitchell SmigieIski ADDRESS 0 rcreFrook Dr. , Florence Owner
(NO.) (STREET) (CONTR'S LICENSE)
Addition Screened Y�I��QDIX Porch NUMBER OF
PERMIT TO 1_) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
80 Acrebrook Drive, Florence ZONING URA
AT (LOCATION) DISTRICT
(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 screened in porch onto rear of existing dwelling
12' X 16'
VOLUME 192 sq. ft. ESTIMATED COST $ 800.00 FEE
(CUBIC/SQUARE FEET) P MIT .di 10.00
OWNER Same as Applicant BUIL�
ADDRESS Same as Applicant's BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY ®RfP