25C-248 (4) ZONING •
DISTRICT
USE
FRONT YARD
SIDE • . SIDE YARD
IX. SITE OR PLOT
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NOTES and Data — (For department use)
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IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — A'umber, stncrt, city, cnu[ Ctntc ZIP code Tel. No.
Owner or i� o,& ��- �-, r� -C���'// ' L� �G /L'1/. ✓� - _l�r�✓
Lessee
2.
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.
Signatu 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 Date
Permit or Approval Check Obtained Number By Permit or Approval Check Obtained 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 �y
Permit number
Building
Permit issued pzeL,'J, 19 _
Building
f
Permit Fee J,
Certificate of Occupancy S
Ap,piRved by:
Drain Tile
Plan Review Fee
TITLE
o To
(rlt� of Xort4aluvtou
�1.4SSM[IjltsCtlS
T Offire of the Nsvertor of 'Puilaings APPLICATION FOR
'L -. ZONING PERMIT AND
Page z. _ Plot j BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. p
,. "] //' /'a fa,'�,// ZONING
I• AT (LOCATION) // "�l � �1<�� '�`` DISTRIC��
LOCATION (N0.) (STREET)
OF BETWEEN AND
BUILDING (CROS,t STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D :00
M
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use IT!
I
1 ❑ New building Residential Nonresidential
2 Addition(If residential, enter number 120 One family 18 ❑ Amusement, recreational
T of new housing units added, if any,
in Part D, 13) 13 F-1 Two or more family — Enter 19 ❑ Church, other religious
number of units— — — — --)� 20 ❑ Industrial
3 ❑ Alteration (See 2 above)
14 ❑ Transient hotel, motel, 21 parking garage
4 ❑ Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (If multifamily residential, of units ——————— — --j- 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)
17❑ Other — SpeciJy 25❑ Public utility
7 ❑ Foundation only
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.
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. y
0
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS / ITl
30❑ Masonry (wall bearing) 40 ❑ Public or private company 48• Number of stories................
31 Wood frame 41 54 Private (septic tank, etc.) 49• Total square feet of floor area, Z.?
all floors, based on exterior �t
32 F-1 Structural steel dimensions ..................... Z
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — Specify 42 X 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 ....................... O
35� Gas Will there be central air
36 52. Outdoors................
Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44 ❑ Yes 45 [X No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — Specify Will there be an elevator? 54. Number of Full..........
46 ❑ Yes 47X No bathrooms Partial........
` R
T
I hereby certify that the proposed work is authorized, by the owner of record
and i have been authorized by the owner to make--thiis`ap-pficatiod as h?s
authorized agent.
SIGNATURE OF AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
zD
DEPT: PILE COPY,
D-
CITY OP NORTHAMPTON BU 1 LDI IVG Q a
NORTHAMPTON MOO. 25C — 248 PERMIT
VALIDATION
DATE March 16, 19 78 PERMIT NO. 54
APPLICANT Adrian Nowak ADDRESS 37 Old Ferry Road
(N0.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Adds -fan (-4') STORY Residence DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) 37 Old Ferry Road ZONING URA
D)STRICT
(NO.) (STREET)
a BETWEEN AND
m (CROSS STREET) (CROSS STREET)
W
a LOT
m SUBDIVISION LOT BLOCK SIZE
a Addition
'0 1330MIS TO BE 16 FT. WIDE BY 16 FT. LONG BY F7. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
f
� (TYPE)
IL REMARKS: TAkiylk% Off rear DOrIfth� adding on a room 16 Z 16 with a crawl space underneath
the mom.
AREA VOLUME ESTIMATED COST $ 6500 FEEMIT $ 21.00
(CUBIC/SQUARE FEET)
OWNER Adrian Nowak
ADDRESS 3� Old Ferry Road, N'ton• e4 `
(Affidavit on reverse side of application to be completed by authorized agent Jowner)