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36-051 (2) Vill. ZONING PLAN EXAMINERS NOTES SIDE YARD SIDE YARD REAR YARD IX. 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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 l�- 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 9 Fee Started y Approved y BUILDING $ PLUMBING $ MECHANICAL $ ELECTRICAL $ OTHER $ VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Permit or Approval Check Date Number By Permit or Approval Check Date Number B Obtained 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 FOR DEPARTMENT USE ONLY Permit number Building ' Use Group Permit issued 19 Building Fire Grading Permit Fee $ t2q' � Live Loading Certificate of Occupancy $ Occupancy Load Approved by: Drain Tile $ Plan Review Fee $ TITLE CITY OF NORTHAMPTON + MASSACHUSETTS $ e OFFICE of the INSPECTOR of BUILDINGS Page Plot APPLICATION FOR INSPECTOR ZONING PERMIT AND BUILDING PERMIT z IMPORTANT — Applicant to complete all items in sections: I, 11, 111, IV, and IX. 0 I• AT (LOCATION) J2_ ZONING�O C n DISTRICT , LOCATION r7(NO•) (STREET) ( BETWEEN C.L mot- AND BUILDING (CROSS STREET) (CROSS TREET) 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 1 ❑ New building Residential Nonresidential 2 Addition(1/ residential, enter number 12 ® One family 18 ❑ Amusement, recreational of new bousing units added, if any, in Part D, 13) 13 ❑ Two or more fami ly - Fnter 19 [❑ Church, other religious 3 Alteration (See 2 above) number of units- - - - -� 20 �❑ Industrial ❑ — 14 L_l Transient hotel, motel, 21 � Parking garage 4 ❑ Repair, replacement or dormitory - Fnter number 5 ❑ Wrecking (11 multifamily residential, of units ------- - -i 22 L station, repair garage enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional Part D, 13) - 16 ❑ Carport 24 I � 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,,,,,,,,,,,,,,,, school, secondary school, college, parochial school, parking garage for department store, rental office building, office building at industrial plant. 7o be installed but not included If use of existing building is being changed, enter proposed use. in the above cost L �'p,^ -I �_ a. Electrical....................... 1 F 4,1 61Y11 Il e+r'p-; CIc l b. Plumbing ....................... Jq 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. E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS ``ii -- 48. Number of stories............ OII� 30 �❑ Masonry (wall bearing) 40j Public or private company 31 Wood Frame 41 Private (septic tank, etc.) 49. Total square Feet of floor area, all floors, based on exterior 32 L_� Structural steel dimensions ..................... 33 �J Reinforced concrete H. TYPE OF WATER SUPPLY 42',xj Public or P rivate company 50. Total land area, sq. ft. .., • 34 Other - S e ct f> _ 43 Private (well, cistern) K. NUMBER OF OFF-STREET PARKING SPACES 51. Enclosed ....................... F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL 35 'L—, Gas Will there be central air 52. Outdoors........................ 36 X Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY 37 j Electricity 44 Yes 45,x. No 53. Number of bedrooms.............. 38 ❑J Coal 39 'I Other - Specify Will there be an elevaror� Full.......... 54. Number of 4IS o r ) Yes 47 N bathrooms �-- Partial....... -DEPT.-OF BUILDING INSPECTIONS BUILDING �° 4 11)V, 66 ! 212 Main Street 0 Northampton, MA 01060 PERMIT <a 36 - 51 VALIDATION DATE J Fi 19 PERMIT NO APPLICANT Sundance Design A- DDRESS ox Northamp on (NO.) (STREET) (CONTR'S LICENSE) Addition One Family NUMBER OF PERMIT TO (_) STORY DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) 12 White Pine Drive ZONING URA AT (LOCATION) DISTRICT (NO.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS; permit for the addition of a kitchen & dining area extension VOLUME 160 so• ft. ESTIMATED COST $ 15,500.00 FEEMIT .� 64.00_ (CUBIC/SQUARE FEET) OWNER David Neal aUIL0, ADDRESS 12 White Pine Dr. , Northampton BY WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY • PINK - ASSESSORS COPY Pl P snow