35-128 (3) ZONING •
DISTRICT
FRONT YARD
SIDE • . SIDE YARD
REAR YARD
LIX. SITE OR PLOT
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NOTES and Data — (For department use)
Z
v
IV. IDENTIFICATION — To be completed by all applicants
_Name— Mailing address — .%'umber, strcct, it>, aml �Iatc ZIP code Tel. No.
Owner or
Lessee
2. Bul Ider's
License No.
Contractor
"i
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
7- 77
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
Fee Started Y Approved Y
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number B Permit or Approval Check Date Number
Obtained Y pp Obtained 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 19 _
Building /
Permit Fee � `t!
Certificate of Occupancy S
i
p e by:
Drain Tile A
Plan Review Fee $_
E
of Northampton
�Ixssc'IC)F1t5Ctts
•' Offzre of the bsprrtor of 39nilbings
APPLICATION FOR
Page�Plot /A � ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, III, IV, and IX. p
ZONING
• AT (LOCATION) �(' f�' ✓��t'7 y�L`/• �--"L;•� DISTRICT—
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
cn
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" ost recent use m
g' m
1 ❑ New building Residential Nonresidential
2 ❑ Addition(I/ residential, enter number 12� One family 18 ❑ Amusement, recreational
of new housing units added, if any, ❑ T family E 19 Church, other religious wo or more amy - Enter in Part D, 13) 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 (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 E] p
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 F771 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 of hospital, elementary
10. Cost of improvement•••..••••..••••• z� 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 $ 7 ,
111. 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
m
30❑Masonry(wall bearing) 40❑ Public or private company 48• Number of stories...............
31 ❑ Wood frame 41 ❑ Private (septic tank, etc.) 49. Total square feet of floor area,
all floors,based on exterior
32 ❑ Structural steel dimensions .....................
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34❑ Other - Specify 42 ❑ Public or private company 50. Total land area, sq. Ft. ...........
430 Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed ....................... t"
O
35 ❑ Gas Will there be central air 52. Outdoors........................
36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44❑ Yes 45 ❑ No 53. Number of bedrooms..............
38 ❑ Coal
39❑ Other - Specify Will there be an elevator? 54. Number of Full..........
46 ❑ Yes 47❑ No bathrooms
Partial.......
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I hereby certify that the proposed work is authorized by the owner of^record
and I have been authorized by the owner to moke•t3ri -',a 't&66 di -his
authorized agent.
'4
SIGNATURE-J&'AGtNT>
ADDRESS
(NUMBER) (STREET) _ (CITY)
APPROVED BY TITLE
DATE 19
DEPT. PILE COPY
ZD
CITY Mp NOR�TM BUILDING a
NOR'Tff 'T't1N, MM. PERMIT VALIDATION
35-228
DATE Septeab= 19 7- PERMIT NO._
APPLICANT Anthony X400M ADDRESS �} 0-11An g93 Drive
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO (_) STORY DWELLING UNITS
YP MP N N0. P PO ED USE?
ZONING
AT (LOCATION) ? OrDRnn®�.l. D]:iw DISTRICT--=
( 0.) {STREET)
m BETWEEN AND
(CROSS STREET) (CROSS STREET)
CL LOT
m SUBDIVISION LOT BLOCK SIZE
a
m 0 BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
f
a (TYPE)
O
LL REMARKS: Con-tnict an. mzt-ode chine; for Wood--Steve
AREA OR VOLUME ESTIMATED COST $ 200 OO FEEMIT . �O.O0
(CUBIC/SQUARE FEET)
OWNER Anthony Enasmam
B
ADDRESS _ 42 O'Donnall Dr3.ve BYIL G
(Affidavit on reverse side of application to be completed by authorized agent of owner)