36-144 (3) ZONING NOTES
DISTRICT
USE
FRONT YARD
'D
SIDE YARD SIDE REAR YARD
NOTES
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NOTES and Dato — (For deportment use)
4
IV, IDENTIFICATION - To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or
Lessee
Builder'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 thi!,,p4licVo9 as his authorized agent and we agree to conform to all applicable laws of this jurisdiction.
Signatur pl Address Application date
-,"e—�a i7,v
NOT WRITE BELOW THIS LINE
V PLAN REVIEW RECORD - For office use
Plans Review Required Check Plan Review Date P y Ions B Date Plans By Notes
Fee Started Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL Is
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 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
Bui Iding• Use Group
Permit issued All A J"- lq
Building - Fire Grading
Permit Fee _ ��
Live Loading
Certificate of Occupancy Occupancy Load
Appr ed,by-
Drain Tile $ r
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
�+ MASSACHUSETTS
r •
OFFICE of the INSPECTOR of BUILDINGS
or Page 3/0 Plot_ APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
ZONING
AT (LOCATION) ✓ J�_ ! �'n -'� �"� DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN
BUILDING CROSS STREET) CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
H
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
-1
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
3 Alteration (See 2 above)
number of units- - - - -� 20 Industrial❑ ��
14 ❑ Transient hotel, motel, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory - Enter number
5 ❑ Wrecking (11 multifamily residential, of units ------- - -i 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 - SpeciJy 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
"�e� processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement................ vo 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 $
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
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 L—] Public or private company 50. Total land area, sq. ft. ..........
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES /
51. Enclosed ......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 ❑ Gas Will there be central air 52. Outdoors........................ Z
36 ❑ oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44E] Yes 45 ❑i No 53. Number of bedrooms.............
38 C..1
39 ❑ Other - Specify Will there be an elevator? Full..........
54. Number of
46 ❑ Yes 47 7_j No bathrooms
Partial.......
Department of Building Inspections
212 Main Street -' BUILDING Z ! '0 . CY)Northampton, Mass. 01060 Oa
PERMIT °�
36 - 144 VALIDATION
DATE June 22, 19 8_ PERM(T NO. 258
APPLICANT Luis C. Rodriq_us ADDRESS 316 Brookside Circle Owner
(NO.) (STREET) (CONTR'S LICENSE)
Addition (_) STORY One Car Detached Carag NUMBER OF
PERMIT TO �.eDWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION)
316 Brookside Circle, Florence DISTRICT �T U
(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 to build a one care garage (detached) approximately 55' from side line
AREA OR VOLUME ESTIMATED COST $ 2f5�0•�� FEEMIT .� 0
(CUBIC/SQUARE FEET)
OWNER Luis C. Rodriqus
Brookside rtc a euILDIN E �)L'/ 'z_j0;
ADDRESS BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - A�SE SORS COPY