12C-091 (3) ZONING •
FRONT YARD
SIDE YAR D SIDE YARD
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants "
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or
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
:� J �✓��.�L�� „✓,icy+._
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 $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Permit or Approval Check Obttai ed 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 FOR DEPARTMENT USE ONLY
Permit number
Building y"i �
Use Group
Permit issued
Building Fire Grading
Permit Fee $ `�� • G��
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile
Plan Review Fee $ �%
TITLE
CITY OF NORTHAMPTON
MASSACHUSETTS
$ OFFICE of the INSPECTOR of BUILDINGS
Plot
Page ��
g APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, II, III, IV, and IX. O
ZONING ,f
I• AT (LOCATION) /r O/-'1 /i a DISTRICT�K
LOCATION (NO.) '—(STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) ICROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V1
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 Res' ntial Nonresidential
2 Addition(If residential, enter number 12 IA I 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
,
number of units- - - -- i 20 Industrial
3 ❑ Alteration (See 2 above)
14 Transient hotel, motel,
4 ❑ Repair, re lacement 21 C� Parking garage
p p or dormitory - Enter number
5 ❑ Wrecking (If multifamily residential, of units ------- - 22 Service station, repair garage
enter number of units in building in 15 ❑❑ Garage 23 L❑ Hospital, institutional
Part D, 13) ❑
16 Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation)
17 ❑ Other - Speci/y 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
w processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement•,•,••,,,......, t Ji 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 r
a. Electrical.....................
b. Plumbing .......................
1 � s
c. Heating, air conditioning..........
d. Other (elevator, etc.)............. zn ,z F /
11. TOTAL COST OF IMPROVEMENT I$
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 ores, 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 ❑ Yes 4S -"', No 53. Number of bedrooms..............
38 ❑� Coal
39 ❑ Other - Specify Will there be an elevator? Full..........
-" �� 54. Number of
❑ D No bathrooms
46 Yes 47 Partial........
a DEPT. OF BUILQING INSPECTIONS BUILDING
! 212 Main Street $a
Northampton, MA 01060 PERMIT
12C - 91 VALIDATION
DATE April 22 86 P RMIT NO. 166
APPLICANT Billy Sullivan ADDRESS 1ck rive er
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO
Addition Breezway NUMBER OF
UNITS
(_) STORY
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE) URA
AT (LOCATION)
5 Rick Drive
ZONING
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS 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: permit for the construction of a breezway connecting the garage to eixsting.'ldwelling
AREA OR 304 sq. ft. ESTIMATED COST $ 1,500.00 FEE
$ 10.00
VOLUME
(CUBIC/SQUARE FEET)
Same as Applicant 1
OWNER BUIL
ADDRESS Same as Ails l icant's BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY pI