12C-064 (3) ZONING
USE
FRONT YARD
REAR YARD
IX. SITE J
�►.- �. -
OR PLOT PLAN For Applicant
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IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or
C, 0v s �r� /c/ S A 610
Lessee p
License Id r 's
e S�7-.5�$3U
Contractor
U go)31a6
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.
Me of applicant Address Application date
?IV � L .
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans By Notes
9 Fee Started y Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL is
OTHER Is
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 FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued 19 _
Building ���� Fire Grading
Permit Fee $ ",Yj Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
TITLE
-- CITY OF NORTHAMPTON
B* .e MASSACHUSETTS
$ f OFFICE of the INSPECTOR of TILDINGS
Page Plot APPLICATION FOR
INSPECTOR
ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, Ill, IV, and IX. O
I• AT (LOCATION) S�' DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS 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 rn
M
1 ❑ New building Reside tial Nonresidential
2 �Addition(lf residential, enter number 12 ne family 18 ❑ Amusement, recreational
of new bousing units added, if any,
13 wo or more famil — Enter 19 Church, other religious
in Part D, 13J y ❑ g
number of units— — — — --> _ 20 �� Industrial
3 Alteration (.See 2 above) 14 l
t
l
t
t h
i
Transenoe , motel,❑ 21 Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
5 El Wrecking (1f multifamily residential, of units ——————— — -- 22 �� Service station, repair garage
enter number of units in building in 15 Garage 23 Hospital, institutional
Part D, 13) 16 r Office, bank, professional
6 ❑ Moving (relocation) �� Carport 24 _�
7 ❑ Foundation only 17 Other — Specify 25 Public utility
26 ❑ School, library, other educational
B. OWNERSHIP 27 Stores, mercantile
8 VPrivate (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,,,,,,,,,,,,,,,, 1;)-G Q()() 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 ....................... �5b 0
c. Heating, air conditioning.......... �J
d. Other(elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT $33 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, v/ ^
all floors, based on exterior
32 ❑ Structural steel dimensions ..................... C
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
50. Total land area, sq. ft. ..........
34 ❑ Other — .Sped/y 42 ❑Public or private company /Z}
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed .......................
35 L1 Gas Will there be central air 52. Outdoors........................
36 ❑�Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 �✓j Electricity 44 ❑ Yes 45 No
53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — Specify Will there be an elevators Full..,......, i
54. Number of
46 [_] Yes 47 J No bathrooms
Partial.......
i a
DeVT. OF BUILDING INSPECTIONS BUILDING ZD � �
+ 212 Main Street Oa
Northampton, MA 01060 PERMIT
12C - 64 VALIDATION
DATE JIIr1P 1, 19 R 9 PERMIT NO. 362
APPLICANT C.ross4nads construction ADDRESS 17R Nnrthwest Rd WPCthampi Qn (1a71hFi
(NO.) (STREET) (CONY R'S LICENSE)
OF
PERMIT TO— (_) STORY DWELLRING UNITS
( F I VEMENT) NO. PRO SED SE)
ZONING ry
AT (LOCATION) DISTRICT URA
(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 a two story addition 540 sq. ft. each floor addition will be a bedroom
and family room
AREA OR
VOLUME 1 000 sq. ft. ESTIMATED COST s 33,000.00 FEEMIT $ 324.00
(CUBIC/SQUARE FEET)
OWNER Keith Moors BU
ADDRESS
9 Harold Street, Florence BY
WHITE WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY • PINK - ASSESSORS COPY p0.11'
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