35-083 (9) ZONING •
FRONT DISTRICT
USE
• .
SIDE YARD SIDE YARD
REAR YARD
IX. SITE OR PLOT
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NOTES and Data — (For department use)
.. f
1.
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address – Number, strccl, crtN, and S[rrtc° ZIP code Tel. No.
�. e. r/t�
Owner or Ad
Lessee
E3uilder's ,q
VC, Q Gt _ `"� T �/ � .�' /� License No.
Contractor
C.
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 Zr
CA az, -.4 DO NOT WRITE BELOW THIS LINE V
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
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date
Permit or Approval Check Obta ned 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
VII. VALIDATION
Building
Permit number
Building
Permit issued � ��� 6i 3LY 19 zZ
Building
Permit Fee $ A-21
Certificate of Occupancy S
Approved by:
Drain Tile � ,�/L ^" �
Plan Review Fee S—
TITLE
�o� roti
of 'Nort4amp#on
$ � �Ixssxdfllsetfs
r Offirr of thv Ynsptrtor of `Puilbings
APPLICATION FOR
ZONING PERMIT AND
Page .-> Plot 7_3 BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. p
ZONING
1• AT (LOCATION) DISTRICT 3 L
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
SUBDIVISION LOT BLOCK SIZE // x
11. 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 ❑ N w building Reside ial Nonresidential
2 Addition(1/ residential, enter rzumber 12 One family 18 ❑ Amusement, recreational
of new bousing 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 motel,,
❑ Repair, replacement y 21 ❑ Se Parking e gorage
4
or dormitory — Enter number
5 F-1 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 ❑ 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
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,,,,,,,,,,,,,,,, 3 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 $ �'t'rj`
III. SELECTED CHARACTERISTICS OF BU1LDING — 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 Rl
30❑ asonry (wall beoring) 40 ❑ Public or private company 48• Number of stories...............
49. Total square feet of floor area,
31 Wood frame 41 ❑ Private (septic tank, etc.) all floors, based on exterior
.rte C�
32❑ Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
42 Public or private company 50. Total land area, sq. ft. ...........
34❑ Other — Specify ❑ p
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ....................... r
'INCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL O
Gas Will there be central air 52. Outdoors........................
conditioning? L. RESIDENTIAL BUILDINGS ONLY
-icily 44 ❑ Yes 45 ❑ No 53. Number of bedrooms..............
1./
ecify Will there be an elevator? 54. Number of Full..........
46 ❑ Yes 47 ❑ 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 t6-make this application as his
authorized agent.
. e
SIGNATURE OF AGENT "
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
Z
DEPT. FILE COPY
o
• - -* BUILDING Qa
CM OF NORTHAN.�F!'DIJ 35-83 PERMIT
VALIDATION
NoR°I'FlAml"iY)N, MASS. o1064
DATE March 30, 19 q�� PERMIT NO. 69
APPLICANT Gary C. Worden ADDRESS 91 Chest=tl Street
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Alter Residence (-J_) STORY Residence DWELLING UNITS 1
(TYPE OFFS IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 1245 Burts Fit Road DISTRICT SR.
(NO.) (STREET)
a BETWEEN AND
a. (CROSS STREET) (CROSS STREET)
LOT
n SUBDIVISION LOT BLOCK SIZE
41
O
O BUILDING IS TO BE 16 FT. WIDE BY 20 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
I (TYPE)
it
LL REMARKS: add Bedrom
AREA OR � PERMIT
VOLUME ESTIMATED COST $ �„.5M.00 FEE 12,00
(CUBIC/SQUARE FEET)
OWNER 71i 01 rian -
BU D I
.,aa a
ADDRESS 12-45 phirtS pit, ROJIAi Florence Mtn BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)
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