36-009 (3) Vill. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YAR SIDE YARD
REAR YARD
NOTES
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, stmt, city, and State ZIP code Tel. No.
71/
Owner or
Lessee
7 t Builder's
License No.
Contractor n 9 y
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.
Sig lure of applicant � Address � p � Application date
f7J 6 v v i2 Ja
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plan Review Date Plans Date Plans
Plans Review Required Check Fee Started BY Approved BY Notes
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Approval Check Date Number Approval Check Date
Permit or A umer
PP N b B Obtained 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 FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued 19
Building Fire Grading
Permit Fee $ -L / Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $Plan Review Fee $ �
TITLE
CITY OF NORTHAMPTON
�• •� s MASSACHUSETTS
$ OFFICE of the INSPECTOR of BUILDINGS
t Page Plot APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 1/111,,, IV, and IX. O
I• AT (LOCATION) (' ( V ktzIy 60A i V [L DIOSTF CTt
LOCATION "° ' `STREET'
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
A. T P OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use M m
1 New building Residential Nonresidential
2 Addition(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 L� Parking garage
4 ❑ Repair, replacement or dormitory — tel
number
5 ❑ Wrecking (It multi family 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,,,,,••,,,,•,,,, r 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 r
a. Electrical.....................
b. Plumbing ..................... \
r ,
c. Heating, air conditioning........
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT
ill. SELECTED CHARACTERISTICS OF BUILDING — For new buildings nd additions, complete Parts E — L;
for wrecking, complete only Part J, for all others skip to IV.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
30 L] 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. ...........
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........................
36 ❑ oil conditioning?
37 ❑ Electricity 44 Yes 45 —' No L. RESIDENTIAL BUILDINGS ONLY
-- 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — .Specify Will there be an elevoto0
Full..........
54. Number of
46 [__1 Yes 47 I❑ No bathrooms
Partial.......
DEPT. QF BUILDING INSPECTIONS BUILDING '-° 4 e ' e'D
! 212 Main Street O<
Northampton, MA 01060 PERMIT <a
36 - 9 VALIDATION
March 12,
DATE 19 87 PERMIT Iv O. 1
APPLICANT Norman O. Sawin ADDRESS orest Glen Drive Owner
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO New Building ,(_) STORY XXXNX Storage Shed NUMBER OF
UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
46 Forest Glen Drive ZONING URA
AT (LOCATION) DISTRICT
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE 10 FT. WIDE BY 20 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: permit for the cosntruction of a new storage shed in rear of existing dwellina
AREA VOLUME 200 so. ft. ESTIMATED COST $ 1 ,000.00 FEEMIT .� 10.00
(CUBIC/SQUARE FEET)
OWNER Same as Applicant BUIL V !IZ
ADDRESS _ Same as e plicantl s _- BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY p241P