36-169 (5) ZONING •
DISTRICT
FRONT YARD
REAR YARD
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Nome Mailing address — Number, street, rrty, anti State ZIP code Tel. No.
Owner or
Lessee / C1 SsY-�
Builder's
2. -e— 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.
Signs fire of pIicon�)t Address Application date
£� r
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans g Notes
q Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
ate ate
Permit or Approval Check Obtained Number By Permit or Approval Check Obto ned 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
II. VALIDATION
Building i FOR DEPARTMENT USE ONLY
Permit number
Building• 19 Use Group
Permit issued
Building Fire Grading
Permit Fee $ � '� ��
Live Loading
Certificate of Occupancy $ Occupancy Load
Appredw by:
Drain Tile $
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
�• MASSACHUSETTS
OFFICE of the INSPECTOR of BUILDINGS
Page Plot l�` APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
-'`J ZONING
I• AT (LOCATION) / / ` / /+�-/'c'/��F /L ` rf6r&t7CIt DISTRICT`
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING — A11 applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use m
M
1 ❑ New building Residential Nonresidential
2 5<1 Addition(If residential, enter number 12 X One family 18 ❑ Amusement, recreational
of new housing units added, if any, 13 F-1 Two or more family - Enter 19 ❑ Church, other religious
in Part D, Se number of units- - - - -�
20 ❑ Industrial
3 ❑ Alteration (See 2 above) 14 l
l
h
Transient hotel, mote ,
❑ 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory - Enter number
5 ❑ Wrecking (1l multifamily residential, of units 22 ❑ Service station, repair garage
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13)
6 ❑ Moving (relocation) 16 ❑ Carport 24❑ Office, bank, professional
7 ❑ Foundation only 17 ❑ Other - Specify 25 ❑ Public utility
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 -- I
local government) �ariT f i n i �- `L
C. COST (Omit cents) Nonresidential - Describe in detail proposed use of buildings, e.g., food
f processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement••••,•,••••,,,•• L L V 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.....................
1 L ll/ liGj i r 4 t`% //trC!r ltd C
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
r
30❑Masonry (wall bearing) 40 ❑ Public or private company . 48• Number of stories...............
31 ® Wood frame 41K Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior
32 ❑ Structural steel dimensions ..................... C:
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other - Specify 42 Public or private company 50. Total land area, sq. ft. ...........
43 M Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL 51. Enclosed ......................
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
/t.���y��
39 Other - Specify :�"'6.1 Wi I I there be an elevator? Full /
54. Number of
46 ❑ Yes 47 C] No bathrooms
..F
DEPT. OF &UILDING INSPECTIONS BUILDING
t 212 Main Street O<
Northampton, MA 01060 PERMIT
36 - 169 VALIDATION
DATE February 22, 19 ��_ 8�_�_ PERM T NO. g5
APPLICANT Daniel Pepin ADDRESS T7=orence Road Home Dyer
IN0.1 (STREET) (CONTR•S LICENSE)
PERMIT TO Addition (_) STORY One FAmily DWELLRING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) 747 Florence Road ZONING
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: addition onto existing kitchen Space
AREA OR 204 sq. ft. ESTIMATED COST $ 3 500.00 PER $ 10.00
VOLUME
(CUBIC/SQUARE FEET) f� 1
OWNER Same as A licants
ADDRESS
ame as Applicants av1D
WHITE - FILE COPY . GREEN - FIELD COPY CANARY - APPLICANT COPY • PINK - ASSESSORS COPY pjID& P