25A-158 (5) Vill. ZONING PLAN EXAMINERS NOTES
DISTRICT
FRONT YARD
REAR YARD
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 w
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or
Lessee 0 16
Builder's
1, 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.
Signat of applicant Address Application dote
00 NOT WRITE B LOW 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 $
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Permit or Approval Check Obtained Number By Permit or Approval Check Obttaaired 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 (f�, CD
Building � �-` `z -- use Group
Permit issued i 19
Building Fire Grading
Permit Fee $ i Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by::�n —
Drain Tile $
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
g+ MASSACHUSETTS
$ OFFICE of the INSPECTOR of BUILDINGS
Plot: � �
Page APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections; 1, 11, 111, IV, and 1X. O
L ZONING (��"xi�
I• AT (LOCA770N1 (STREET) DISTRICT�l7l SLro/r)
LOCATION
(NO.) (STREET)
OF BETWEEN od 1/�1I1� _AND
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(//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 n Industrial
14 Transient hotel, motel, 21 Parking garage
40 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) Public utility
17® Other – Specify 25❑ y
7 Foundation only c� pro ( ��� 26 School, library, other educational
B. OWNERSHIP 0-115 /_�!!YoffZel 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
1 processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement,,••,••,•••,•••• LI OQ t 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.....................
—vl ll
b. Plumbing .....................
c. Heating, air conditioning.........
d• Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT I$ O
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 L] Masonry (wall bearing) 40 F—] Public or private company 48. Number of stories...............
31 Wood frame 410 Private (septic tank, etc.) 49. Total square feet of floor area, ,
all floors, based on exterior f
32 Structural steel dimensions .....................
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 I. TYPE OF MECHANICAL 51. Enclosed ......................
35 Gas Will there be central air 52. Outdoors........................
36 Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 L J Yes 45 2IQ No
53. Number of bedrooms..............
38 Coal
39 n Other — Specify Will there be an elevotor) Full.......... —
54. Number of
46 �? Yes 47:N No bathrooms
Partial.......
DEPT. OF"BUILDING INSPECTIONS BUILDING Z O
212 Main Street 'Q
` Northampton, MA 01060 PERMIT
I IL
25A - a% VALIDATION
DATE October 21 ly 86 PERMIT NO. 622
APPLICANT Dianne C. LaRock ADDRESS 42 or-77treet Owner
(NO.) (STREET) (CONTR'S LICENSE)
New Building Screen House NUMBER OF
PERMIT TO (�_) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION)
242 North Street ZONING
DISTRICT UR8
(N0.) (STREET)
BETWEEN AND_
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE 16 FT. WIDE BY 10 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS, permit for the construction of a screened in building in rear of existing dwelling
AREA OR VOLUME 160 sQ. ft. ESTIMATED COST $ 400.00 FEE MIT 10.00
(CUBIC/SQUARE FEET)
OWNER Same as Applicant
ADDRESS Same as Applicant's BUIL
BY
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WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY pJNT` ''p
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