35-028 (3) a ..a. .w. u. ...............
Vill. ZONING PLAN EXAMINERS NOTES
DISTRICT
SIDE YARD SIDE YARD
IX. SITE OR PLOT PLAN For Applicant Use
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NOTES and Data — (For department use)
1 '
M Y R 0 N F. CLARK ' ' ' ' CENERAL CONTRACTOR
Dial 586-1027 21 No. Maple St. J Florence, Mass. 01060
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IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — A'rmiber, sln•cl, cif%, rtrlr( Slate• ZIP( code Tel. No.
Owner or --� 1V 6,0
Lessee
Builder'N s
License o.
Controctor / _
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
Ar 00 NOT WRITE B E L 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
rova Check I Cec Date Approval Check Date
Permit or A u
pp Obtained Number B 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 V y
Building
Permit issued
Building r
Permit Fee $
Certificate of Occupancy S
Approved by:
Drain Tile S
Plan Review Fee S—
E
� o
Crit� of Nort4ainptou
� � �l'ilassxcl?nsetfs
.' Office of the �naptrtor of 'Puilbirps
APPLICATION FOR
�- ZONING PERMIT AND
Plot
Page :� BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, III, IV, and IX. p
ZONING
I• AT (LOCATION) DISTRICT
LOCATION (NO.) �` (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING - All applicants complete Parts A - D 7�0
M
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
1 ❑ New building Residential Nonresidential
2� Addition(If residential, enter number 12❑ One family IS ❑ 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 F-1 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)
17❑ Other — Specify 25 ❑ Public utility
7 ❑ Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
Vr;,Private (individual, corporation, 28 ❑ Tanks, towers fir _
nonprofit institution, etc.) 2� Other — Specify O)EF«
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. y
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS / O
/ m
30 asonry (wall bearing) 40 ❑ Public or private company 48• Number of stories..............
49. Total square feet floor area,
31 Wood frame 41 ❑ Private (septic tank, etc.)
all floors, based on exterior r,q
32 ❑ tructural steel dimensions .................... �V
33 ❑ Reinforced concrete H. T PE 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
51. Enclosed ...................... r
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL O
35 ❑ Gas Will there be central air 52. Outdoors................../... /
conditioning?
36 ❑ Oil L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 ❑ Yes 4� No 53. Number of bedrooms..............
3f� Coal ``CC
39 ❑ Other — Specify Will there be an elevator? 54. Number of Full..........
46 ❑ Yes 47 MCA No bathrooms partial.......
I hereby certify that the proposed work is authorized by the owner of record
and I have been authorized by the owner to make this 6pplication a's''his
authorized agent.
r
SIGNATIJ?E OE 'AGENT '
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
NO
DEPT.' FILE COPY
Z
CITY OF NORTHAMPTON BUILDING a a
NoRTHAMP'w, MAM. PERMIT VALIDATION
35-28
DATE Nonenlbsr I S. 192_ PERMIT NO. ,542
APPLICANT Mymn Mark ADDRESS 21 Nd. Ms:n B .�ifi.! Fy0•
(No.) ( TREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Phisti ps Addition (_I—) STORY Offi no DWELLING UNITS
(PR
(TYPE OF IMPROVEMENT) NO. POSED USE)
ZONING
AT (LOCATION) R
VAY1 Rosa DISTRICT SIR(NO.) v IS
a BETWEEN AND
b (CROSS STREET) (CROSS STREET)
O�
LOT
IL SUBDIVISION LOT BLOCK SIZE
m
U BUILDING IS TO BE 0# 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
I (TYPE)
K
uO REMARKS. _Addition for O-PP-ICS cnona
AREA OR VOLUME inn ESTIMATED COST $ 2500-00 FEMIT
E $ I,Q_nn
(CUBIC/SQUARE FEET)
OWNER R171 Willa3:d Tnr_
BUILDIN DE
**
ADDRESS 182 Nn Elm Rt- - No-thampton, Mao-- BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)
now