25A-119 (7) ZONING •
DISTRICT el P,��
USE
FRONT - .
SIDE YARD SIDE - .
REAR YARD
IX. SITE • • PLOT PLAN For Applicant
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NOTES and Data — (For department use)
A-4 /'4 -C i lf. r3 --C)
1
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — .%'umhcr, struc•t, cifN, inrl Strrtc° ZIP code Tel. No.
Owner or
Lessee
Contractor —f—L��l
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 ap licant Address Application date
sl
61.6 > 6-28-77
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans By Date Plans By Notes
Fee Started Approved
BUILDING
PLUMBING S
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or A rovaI Check Date Number B Permit or Approval Check Date Number B
pp Obtained y pp Obtained 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 269
Building
Permit issued June 28. 197_
Building
Permit Fee $ 10.00
Certificate of Occupancy S
prove by: j'�
Drain Tile S
Plan Review Fee S-
T n(-al Tn,- -tor
TITLE
0 0
�l&SSF1C{f1lStttS
T Office of the hoptrtor of `Puilbings
APPLICATION FOR
Pagers Plot l ZONING D
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. p
Z O N I N
I. AT (LOCATION) / "�'yaCx"�'` '�'s`C� DISTRCIW
LOCATION (NO.) (STREET) \
OF BETWEEN AND �}
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
Cn
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D M
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
1 ❑ New building Residential Nonresidential
2�Addition(lf residential, enter number 1 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— — — — i 20❑ Industrial
3 ❑ Alteration (See 2 above) 1q ransient hotel, mote ,
❑ T l l 21 ❑ Parking garage
4❑ Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (If 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)
7 F7 Foundation only 17X Other — SpeciJy 25❑ Public utility
` 26❑ School, library, other educational
B. OWNERSHIP a ' j�(� 27❑ Stores, mercantile
28 ❑ Tanks, towers c7
8 ®` Private (individual, corporation, � ,( 29❑ Other — Specify
nonprofit institution, etc.) o �—
9 ❑ Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food
I 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.)............. /f
11. TOTAL COST OF IMPROVEMENT 1$
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
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS > M m
30❑ Masonry (wall bearing) 40 ❑ Public (r pP&14,n y 48• Number of stories..............
31 ❑ Wood frome 41 ❑ Private se t c .) 49• Total square feet of floor area,
all floors, based on exterior
32 ❑ Structural steel dimensions
33 ❑ Reinforced concrete H. TYPE OF WATE SUPPLY
34 Other — Specify 42 ❑ Public o Acom pany 50. Total land area, sq. ft. ...........
43 ❑ Private ( el tern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL 51. Enclosed ....................... r
35 ❑ Gas Will there be central air 52. Outdoors........................ O
36 ❑ Oil �J conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 Electricit 44 Yes 45 No
❑ Y ❑ ❑ 53. Number of bedrooms.............. '1)
38 ❑ Coal
39 ❑ Other — Specify Will there be an elevator? Full..........
54. Number of
46 ❑ Yes 47 ❑ No bathrooms
Partial.......
hereby certify that the proposed work is authorized. by ::the owner-ofrecord
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
'j Z 0
CITY OF NORTHAMPTON BUILDING I a
NORTHAMPTON, MASS. PERMIT
VALIDATION
DATE June 28, 19 77 PERMIT NO. 269
APPLICANT M. J. LaFrance ADDRESS 6 Sherman Avenue
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TOR A-I h017R (`) STORY rrAenhou-,e DWELLING UNITS
(TY E OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 12 Sherman Avenue DISTRICT URB
(NO.) (STREET)
a BETWEEN AND
(CROSS STREET) - (CROSS STREET)
a
(L LOT
m SUBDIVISION LOT BLOCK SIZE
V
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
f (TYPE)
O:
a REMARKS: -Install P ho 1G . on a. sPrma.nent follnda+Jon 151-0 X'9r-C)I'
VOLUME ESTIMATED COST $ FEEMIT
(CUBIC/SQUARE FEET)
OWNER M. J._TP.Fra.nCP
ADDRESS 6 Sherman Ayenue,Nnrthamgtnn B D
(Affidavit on reverse side of application to be completed by authorized agent of owner)