36-165 (4) ZONING •
DISTRICT
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
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NOTES and Data — (For department use)
w
IV. IDENTIFICATION - To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner Or
Lessee
2. /y/i/t�/C 411=-114 /O �-GG` G /� /> LBcens er'No.
Contractor
T -7 b. 071
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.
Signature of applicant Address 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
q Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date D
Permit or Approval Check Obtained Number By Permit or Approval Check Obttait 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 / FOR DEPARTMENT USE ONLY
Permit number
Building � n r/ Use Group
Permit issued C �7 19
Building `� Fire Grading
Permit Fee $ � (�
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $ � t
Plan Review Fee $
TITLE
y CITY OF NORTHAMPTON
MASSACHUSETTS
$ OFFICE of the INSPECTOR of BUILDINGS
.at Page Plot — APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all iittJ�ems in sections: 1, 11, 111, IV, and IX. O
7/ 7 �L �t� i // ZONING
1• AT (LOCATION) (•r ( DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN 7 AND /_?G1/f T P 77 /P0
BUILDING (CROSS STREET) (CROSS STREET)
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
M
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
number of units— — — — -� 20 L❑ Industrial
3 ❑ Alteration (See 2 above) _
14 ❑ Transient hotel, motel, 21 C_� 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)
7 L:] Foundation only 17❑ Other — Speci/y 25 ❑ Public utility
26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8 [)q 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
,{ j processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement,,•••••••,••..•. ode 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 ..................... 9.6
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
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 EX] Electricity 44 ❑ Yes 45i, No
_—: 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — Specify Will there be an elevators Full..........
— 54. Number of
46 [-1 Yes 47 J No bathrooms
Partial.......
a DEPT. 6F BUILDING INSPECTIONS BUILDING ° (�
! 212 Main Street Oa a.
Northampton, MA 01060 PERMIT
36 - 165 VALIDATION
DATE April 24, 19 86 PERM NO 179
APPLICANT American Pioneer Builders ADDRESS Lou yi e Rd., asthamp on
(NO.) (STREET) (CONTR'S LICENSE)
Living oom NUMBER OF
PERMIT TO Addition (_) STORY g DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
795 Florence Road ZONING SR
AT (LOCATION) DISTRICT
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
VAV�D�D��WIT7��I�OyN
�TADDI 1{ IS TO BE 16 FT. WIDE BY 12 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 onto existing single family dwelling (living Room)
AREA OR $ 5,000.00 PERMIT s 20.00
VOLUME 192 sq. ft ESTIMATED COST
(CUBIC/SQUARE FEET)
OWNER Bob Lafluer '
orence RoaT BU I LD I
ADDRESS BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY