25C-058 (4) ZONING •
DISTRICT
FRONT YARD
SIDE YARD SIDE
REAR YARD
NOTES
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
14ame Mailing address — Number, street, city, and State ZIP code Tel. No.
l S
O.wner or
r
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.
Signature of applicant 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 By Date Plans By Notes
Fee Started Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER Is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or A roval Check Date Number B Permit or Approval Check Date Number PP Obtained y Pp N b By
y
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_
Permit issued L 19 8 Use Group
Building Fire Grading
Permit Fee $ ('r
Live Loading
Certificate of Occupancy $ Occupancy Load
Ap v,e by
Drain Tile $ /�
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
MASSACHUSETTS
$ OFFICE of the INSPECTOR of BUILDINGS
Page Plot APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. t O
. Cr !/ ZONING T'
I• AT (LOCATION) -''L�'-`_%f '1.� -� DISTRICT`
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V1
II. TYPE AND COST OF BUILDING — AIf 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 u One family 18 Amusement, recreational
of new housing units added, if any, 13 Two or more family - Enter 19 Church, other religious
in Part D, number of units- - - - -
3 � Alteration (See 2 above) -jo- 20 Industrial
14 Transient hotel, motel, 21 Parking garage
4 Repair, replacement or dormitory - Enter number
5 ❑ Wrecking (11 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 Foundation only 17 Y 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
local government)
C. COST (Omit cents) Nonresidential - Describe in detail proposed use of buildings, e.g., food
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.
7'o be irstalled 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 Is i,'P,
III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L;
for wrecking, complete only Part J, for aft others skip to IV.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
30� asonry (wall bearing) 40 Public or private company 48• Number of stories..............
31 VWWood frame 41 D Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior
LIP
32 Structural steel dimensions
33 n Reinforced concrete H. TYPE OF WATER SUPPLY
34 Other - Specify 42 �ublic 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 L] Gas Will there be central air 52. Outdoors........................
conditioning?
36 it L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 D Yes 450 53. Number of bedrooms..............
38 Coal
39 Other - Specify Will there be an elevator? Full..........
54. Number of
46 � Yes 47 E/No bathrooms
Partial........
Department of Building Inspections
12 Main Street
forthampton, Mass. 01060 BUILDING z°
25C - 58
PERMIT atL ' on
VALIDATION
DATE September 23, 19 83 PERMIT NO. 481
APPLICANT Walter Struthers ADDRESS 25 Lincoln Avenue N/A
(NO.) (STREET) (CONTR'S LICENSE)
Storage Shed Two Family NUMBER OF
PERMIT TO (_) STORY DWELLING UNITS _
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
5 Lincoln Avenue ZONING URB
AT (LOCATION) DISTRICT
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT p
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE 12 FT. WIDE BY 16 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: permit to build a storage shed
AREA OR 192 sq. ft. 800.00 PERMIT 10.00
VOLUME ESTIMATED COST $ FEE $
(CUBIC/SQUARE FEET)
OWNER Walter Struthers ��r' � ,
ADDRESS 25 Lincoln Avenue, Northanpton BY BU
WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY ■ PINK - /SSESSORS COPY