35-082 (7) ZONING •
DISTRICT
I USE
FRONT 1
. ,
SIDE YARD
' V A • .
_d
REAR YARD
NOTES
IX. SITE • ' PLOT
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NOTES and Data — (For deportment use)
� t
IV. IDENTIFICATION — To be completed by all applicants
4�
Name Mailing address — A'umbcr, .street, rrtN, and Ctrrtr' ZIP code Tel. No,
1.
Owner or
Lessee
B"Ider'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.
Signature of applicant Address Application date
Iq
r,
D0 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
Fee Started Y Approved Y
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER Is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Dote Number B Permit or Approval Check Date Number B
Obtained Y pp e
_ Obtained 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
VI1. VALIDATION
Building
Permit number
Building
Permit issued �T� 19 _
Building
Permit Fee � 1
Certificate of Occupancy S
Approved by:
Drain Tile
Plan Review Fee S.
T
(rx#y of Xoxt4aulptoll
�IassxCltttBetfs
(office of the Ynsperfor of jgnilbilgs APPLICATION FOR
Page Plot 55 ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. Z
I• AT (LOCATION) �:1�)'7f ;%` ZR-�/`-°T.� .% (' '� ( f
DISTRICT,.' R
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
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
m
-a
1 ❑ New building Residential Nonresidential
2 ❑ Addition(If residential, enter number 1z 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— — — — -- `
3 Alteration (See 2 above) 20 Industrial X
14 ❑ Transient hotel, motel, ❑
4 ❑ Repair, replacement 21 ❑ Parking garage
or dormitory — Enter number
5 ❑ Wrecking (If multifamily residential, of units ——————— — --). 22 ❑ Service station, repair garage s
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 E] Public utility
7 ❑ Foundation only 26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8,A Private (individual, corporation,
28 ❑ Tanks, towers
nonprofit institution, etc.) 29❑ Other — Specify
9 ❑ Public (Federal, State, or
local government) t
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, �y
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 $
Ill. 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. D
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........ /......' m
31 Wood frame 41�Private (septic tank, etc.) 49. Total square feet of floor area,
VN all floors, based on exterior
32❑ Structural steel dimensions ............o .......
33 Reinforced concrete H. TYPE OF WATER SUPPLY i
❑ )
34 ❑ Other — SpeciJy 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........:!r'-'........
....
36 ❑ Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37❑ Electricity 44❑ Yes 45"X No 53. Number of bedrooms.....
38 ❑ Coal
39 ❑ Other — Specify Will there be an elevator? Full...
54. Number of ••• ••
46 ❑ Yes 47 XNo bathrooms
'' Partial........
I hereby certify that the proposed work is authorized by the .owner Qf record
and I have been authorized by the owner to-make this application as his
authorized agent.
SIGNATURE OF AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE ]9
DEPT: FILE COPY
CITY OF NORTHAMPTON B U I L D!IV G 0 4
NoRTHAmmN, mos. 01060 35-82 PERMIT 35-82 VALIDATION
DATE RabniarV 14, 197_ PERMIT NO, 26
APPLICANT_ Unda Sarafin ADDRESS 12 5 Burts Pi-t; Road
(N0,) (STREET) (CONTR'S LICENSE)
OF
PERMIT TO Altar RP.Si dA _
n Q ( 1 ) STORY Residence DWELLLRING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) 1p 5L_R r n Pit Rnad ZONING SH
DISTRICT
(N0. (STREET)
a BETWEEN AND
(CROSS STREET) (CROSS STREET)
a
IL LOT
m SUBDIVISION LOT BLOCK SIZE
V
O BUILDING IS TO BE 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
f
� (TYPE)
a REMARKS: Change attached garage to room
VOLUME ESTIMATED COST � 5nQ.nn FEEMIT I.0,00
(CUBIC/SQUARE FEET)
OWNER Linda & Edward Sarafin k
BUI DIN EPT.
ADDRESS . 3255_Rj-r"tS Pit Road BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)