36-169 (4) Vill. ZONING PLAN EXAMINERS NOTES
DISTRICT
IX. SITE OR PLOT PLAN For Applicant Use
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name j �y/Mailing address — Number, street, city, and Slate ZIP/code Tel.
�/No. /
1.Owner or Cc✓t I L° l C l v� � [ f/V✓�GZC Z � &K e"C,-e V��[(� �T-5,Y-7 CA
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 this application as his authorized agent and we agree to conform to all applicable laws of this jurisdiction.
Si�of nt Addr ess Application date
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
Do D
Permit or Approval Check Obttai ed Number By Permit or Approval Check Obtta t ed 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 q FOR DEPARTMENT USE ONLY
Permit number
Building ^ Use Group
Permit issued g�' J 19 36
Building Fire Grading
��°�
Permit Fee $ Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
$ err _
Drain Tile
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
�. MASSACHUSETTS
$ OFFICE of the INSPECTOR of BUILDINGS
IV T
Page — APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: I, I1, 111, IV, and IX. O
{ ZONING
I• AT (LOCATION) -2 �1Y� �•--� �.-1/
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION _ LOT BLOCK SIZE
V1
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 ❑ w building ResidepAlim Nonresidential
2 VAddition(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— — — — f 20 L❑ Industrial
3 ❑ Alteration (See 2 above)
14 Transient hotel, motel,
21 Parking garage
4 ❑ Repair, replacement or dormitory — ?refer number
5 ❑ Wrecking (If multifamily residential, of units ------- — i 22 ❑ Service station, repair garage
enter number of units in building in 15 L❑ 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
B. OWNERSHIP 27 ❑ Stores, mercantile
6 Privote (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
a� processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement,,,,•.,.,....... U 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..................... J ( I f /�f ✓`t
b. Plumbing ..................... f i
c. Heating, air conditioning
d. Other (elevator, etc.)............
11. TOTAL COST OF IMPROVEMENT $ 75' &L-,(�c6an
III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E A 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..............
49
31 Wood frame 41 ❑ Private (septic tank, etc.) . Total square feet floor area,
all floors, based on exterior
32 ❑ Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — Specify 42 F—] 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? L. RESIDENTIAL BUILDINGS ONLY
Electricity 44
37 �,
❑ [—_] Yes 45 ! NO 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — Specify Will there be an elevator? Full..........
l 54. Number of
46 ❑ Yes 47 `J No bathrooms
Partial........
l a DEPT. OF BUILDING INSPECTIONS BUILDING Z°
! 212 Main Street $IL E
Northampton, MA 01060 PERMIT
36 - 169 p VALIDATION
DATE September 18, 19 86 PERMIT NO. 544
APPLICANT Daniel Pepin ADDRESS 747 Florence Road Owner
IND.) (STREET) (CONTR'S LICENSE)
OF
PERMIT TO Addition (_) STORY Attached Deck DWELLRING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USEI C
AT (LOCATION) 747 Florence Road DIOSTR CT SR
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
DECK IS�y
XXtlWAWWIX TO BE 14 FT. WIDE BY 14 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 an attached deck to the south side of existing dwell-jag
AREA OR PERMIT
VOLUME 1�� S T_ Ft._ ESTIMATED COST $_ 1 ,000-00 FEE 10-00
(CUBIC/SO DARE FEET)
OWNER lamp as Applicant
BUILDING
ADDRESS Same as App l i r a nt's BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY - PINK - ASSES ORS COPY pJNT p