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29-286 (5) ZONING • F DISTRICT I USE FRONT SIDE • SIDE YARD REAR YARD _ IX. 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IDENTIFICATION — To be completed by all applicants Name p Mailing address — Number, stmt, city, and State }ZIP code Tel. No. 1. �� 8 �� Q f U t:► 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. Signatu 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 V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Date Date Permit or Approval Check Obtained Number By Permit or Approval Check 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 / 190 Building Fire Grading Permit Fee $ Gac Ud Live Loading Certificate of Occupancy $ Occupancy Load prove by: Drain Tile $ Plan Review Fee $ TITLE �o, o CITY OF NORTHAMPTON MASSACHUSETTS B � OFFICE of the INSPECTOR of BUILDINGS Page Plot APPLICATION FOR ZONING PERMIT AND INSPECTOR BUILDING PERMIT IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. / O n ZONING UR-A I• AT (LOCATION) 018 �� 10 DISTRICT LOCATION (NO.) (STREET) OF BETWEEIJ _AND BUILDING (CROSS STREET) (CROSS STREET) LOT SUBDIVI'>ION LOT BLOCK SIZE N II. TYPE AND COST OF BUILDING — A11 applicants complete Parts A — D A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use rn rn 1 ❑ New building Residential Nonresidential 2,KAddition(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— — — — ---)' 20 ❑� Industrial 3 ❑ Alteration (See 2 above) 14 Transient hotel, motel, ❑ 21 ❑ Parking garage 4 ❑ Repair, replacement or dormitory — Enter number 5 ❑ Wrecking (it 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) 7 �� Foundation only 17❑ Other — Specify 25 ❑ Public utility 26 ❑ School, library, other educational B. OWNERSHIP 27 ❑❑ Stores, mercantile 8 Private (individual, corporation, 28 ❑ Tanks, towers nonprofit ins°itution, 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................ U d �� school, secondary school, college, parochial school, parking garage for, department store, rental office building, office building at industrial plant. To be irsta,'led but not included If use of existing building is being changed, enter proposed use. in the above cost a. Electrical....................... b. Plumbing ..................... c. Heating, cir conditioning....... d. Other (elevator, etc.)............. 11. TOTAL COST OF IMPROVEMENT $Sb a�`0`0 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 TYP1= OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS / 30❑ Masonry (wo I bearing) 40 © Public or private company 48. Number of stories............... r r 31 Wood frame 41 L❑ Private (septic tank, etc.) 49. Total square feet of floor area, t�—CC n33--d all floors, based on exterior fy 11 32 Structural steel dimensions ..................... (a 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 D Gas Will ther be central air 52. Outdoors........................ conditioning. 36 r Oil L. RESIDENTIAL BUILDINGS ONLY 37 Electricity 44 �] Yes 45 '— No 53. Number of bedrooms............. 38 Coal 39 Other — SP, city 1.�✓ " ' WiII th a be an elevator? Full.......... 54. Number of 46 Yes 47 '❑ No bathrooms Partial....... ITC7 Tr Wo 4 .,._4 nent of Bbilding Inspections 212 Main Street BUILDING "° Northampton, Ma. 0010 PERMIT a 29 - 286 vaLlDanoN DATE _ A rp it 7, 19 A2 PERMIT NO. 117 APPLICANT gamlapl Adams ADDRESS 28 ppneasal /I, (N0.) (STREET) (CONTR'S LICENSE) PERMIT TO Addition ( 1 STORY Duel NUMBER OF ----- DWELLING UNITS � (TYPE OF IMPROVEMENT) NO. (PROPOS USE) ) ZONING AT (LOCATION) _ 2R Qpncasal Drive DISTRICT lTRA (NO.) (STREET) BETWEEN AND (CROSS STREET) (Cft055 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: N-W sAA4tinn 1st- floor bedroom and addition to kitchen AREA OLUME 495 ESTIMATED COST $ 5000.00 FEEMIT 20.00 (CUBIC/SQUARE FEET) OWNER ,S ""� Adams BUIL T ADDRESS RQACAs$1 nr4mey Northampton, Ma 01060 BY i 2� WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - A SESSORS COPY