36-130 (2) Vill. ZONING PLAN EXAMINERS NOTES
DISTRICT
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be comp/eted by a// applicants
Name Mai ling address Aumbcr, �Irccf, cit�, cimi �tatc ZIP code Tel. No.
O�ner or
Lessee
Contractor
3.
Architect or
Engineer
I hereby certify that the proposed work is authorized by the owner of record and tlict 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 Iurisdiction.
Signature of a I'c" it Address Application date
00 00T WR | TE BELOW TH | S L | NE
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
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date )ate
Permit or Approva I Check Obtained Number By Permit or Approval Check ObEtained 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 —A
Building -�7
Permit issued
Building
Permit Fee $
Drain Tile Fe�, /
Plan Review Fee
TITLE
_
o� o
�IM$SRCI)1t5ftt8
Offire of the �navertor of 'Builbings APPLICATION FOR
_Plot ZONING PERMIT AND
Page ' BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: I, 11, 111, IV, and IX. p
f� ZONING
I• AT (LOCATION) -v� 5� Y `+?T���irti I /l'L�Ldf .+ r�� l DISTRICT
LOCATION (N0.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
II. TYPE AND COST OF BUILDING — A11 applicants complete Parts A — D X1
M
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
1 ❑ New building Resid ntiol Nonresidential
2 F-1 Addition(If residential, enter number 12 FOne 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 ❑ 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 Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation)
17 Other — Speci/y 25 ❑ Public utility
7 ❑ Foundation only
26 ❑ School, library, other educational
i o
B. OWNERSHIP /')�'�% /7"P 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.
To be insealled 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 $.
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. y
0
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. ...........
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ....................... r
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 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........
I hereby certify that the proposed work is authorized by the owner of '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 19
DEPT: FILE COPY
Z
M
BUILDING 2 IL
CITY OF NORTHAMPTON
PERMIT < VALIDATION
NORTHAMMN, MASS. 36-130 p
DATE December 28, 19 77, PERMIT NO. X42
APPLICANT No" Re Beverly jnbnaon ADDRESS_�c15 Rrnnk of Fie Ciro a_ 1►t►tnn
IN0.)� (STREET) ' (CONTR'S LICENSE)
NUMBER OF
PERMIT TO (�_1 STORY W00d—bvrUi12g StOYe DWELLING UNITS
(TYPE OF IMPROVEMEN NO. (PROPOSED USE)
ZONING
2
AT (LOCATION) 9!G Brookside MrQ1e DISTRICT I]RA
(NO.) (STREET)
01 BETWEEN AND
'D (CROSS STREET) _ (CROSS STREET)
rn
LOT
D' SUBDIVISION LOT BLOCK SIZE
m
a
U
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
I - (TYPE)
O:
u- REMARKS: Mastan= nhinnnner for unrid— n]rniyrkg Lstnve
AREA OR
VOLUME ESTIMATED COST $_x,50-M FEEMIT $ 1Q.00
(CUBIC/SQUARE FEET)
OWNER Oses`r & Beverly 7ehn,ann
ADDRESS 299 Brookside Circle N'ton. E
(Affidavit on reverse side of application to be completed by authorized agent of owner)