28-018 (3) ZONING •
f
rI _ i .���
FRONT •
SIDE YARD SIDE YARD
REAR YARD
IX. SITE OR •
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NOTES and Data — (For department use)
If log
IV. IDENTIFICATION — To be completed by all applicants •
Name Mailing address — Number, stmt, city, anri State ZIP code Tel. No.
1.
Owner or
S >� �C � 5`� 2� 3 S ��/�-5 T_'T 2�
Lessee
2, l. ii!//} �(d�Ss Builder's
L
�/ � I�E w icense No.
Contractor _
D� Ltic f, 2 P 2 b`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.
Sign lure 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 P y
n Ions B Date Plans By Notes
Fee Stoed Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL Is
OTHER Is
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approva I Check Date Number B Permit or Approval I Check Date Number B
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 FOR DEPARTMENT USE ONLY
Permit number
Building. Use Group
Permit issued 19
Building Fire Grading
Permit Fee $ �, //� Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $ f
TITL
CITY OF NORTHAMPTON
B• MASSACHUSETTS
s +
e OFFICE of the INSPECTOR of BUILDINGS
,yt Page �' �❑ Plot �� APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, III, IV, and IX. O
• AT (LOCATION) � /�•• ✓ t G�� ZONING
y DISTRICT_�
LOCATION (NO.) (STREET) �j
OF BETWEEN �7`•<I 't-' A b 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 im
M
1 ❑ New building Residential Nonresidential
2 Addition(I residential, enter number
1` 12 One family 18 E] Amusement, recreational
of new bousing units added, if any, 13� Two or more family — Enter 19 ❑ Church, other religious
in Part D, 13) number of units— — — — -•)�
3 Alteration (See 2 above) 14 Transient hotel, mote 21 ❑ Industrial
hll,
❑ 21 �� Parking garage
4❑ Repair, replacement or dormitory — Enter number 22 ❑ Service station, repair garage
5 ❑ Wrecking (if multifamily residential, of units ——————— — -i
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 — Specify 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.
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 .....................
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
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 ❑ Gas Will there be central air 52. Outdoors........................
36 FOil conditioning?
� L. RESIDENTIAL BUILDINGS ONLY
37 L J Electricity 44 Yes 45 ❑ No
53. Number of bedrooms.........
38 Coal ( (X
39 ❑ Other — Specify Will there be an elevator? Full... .....
— 54. Number of
46 [:] Yes 47 ❑ No bathrooms
Partial......
Departm t of Building Inspections
212 Main treat BUILDING ZD
Northampton, M., 01060 PERMIT �a � �
28 - 18
VALIDATION
DATE nctnhpr 27- 19 R2 PERMIT NO. 614
APPLICANT ThpnAnrp Al olive,t ADDRESS 12_� MpaAnc+ 009039
(NO.) (STREET) (CONT R'S LICENSE)
NUMBER OF
PERMIT TO ( ) STORY b11%0- 0 DWELLING UNITS 01 OF IMPROVEMENT) N (PROPOSED USE)
ZONING
AT (LOCATION) DISTRICT RR
(NO.) ( TREET)
BETWEEN AND
(CROSS STREET) (GROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: RpmavP partitinri� replace beam, new bath on 1St floor, renovate bath on 2nd. fl.
AREA OR ESTIMATED COST $ 15_000 FEEMIT $ 60_00
VOLUME
(CUBIC/SQUARE FEET)
OWNER Tustin West - BUILDIN DEP .
ADDRESS 703 Sylvester RA„ Northampton, Ma- 0106n BY
WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY PINK - ASSESSORS COPY