17A-158 (4) ZONING •
DISTRICT
USE
IFRONT YARD
SIDE YARD SIDE - •
REAR YARD
NOTES
IX. SITE • - PLOT PLAN For . •♦
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Cot-
-_ Name M 'ling a ss — .A'gun n°r 1, cit%, aml State' ZIP code Tel. No.
1. ? \
Owner or " ' �/ ti� v /'o q
Lessee —rviS ,�a�q�F S lam' 1 69, ���
7
L. C�Qi Builder's
License No.
Contractor
'7) "` ` h C red c -.✓i, G SS ---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 thi application as his authorized agent and we agree to c iform to all applicable laws of this jurisdiction.
Signatur 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 Date Plans
Fee Started By Approved BY Notes
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
rova I Date Date
Permit or A
PP 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
Permit number
Building
Permit issued 19
Building `r
Permit Fee $T"4. /_�/xl
Certificate of Occupancy S
App by:
Drain Tile
Plan Review Fee _
TITLE
■
� � �Tilassxcl}ttsetfs
.' (office of the �ns}tertor of '3uilbings
APPLICATION FOR
ZONING PERMIT AND
Page Plot BUILDING PERMIT
IMPORTANT — Applicant comp a all items in tions: 1, 11, III, IV, and IX. p
I. )< Sl3 DIOSTR C
AT (LOCATION)
LOCATION (NO.) (STREET /
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT _BLOCK SIZE
f�
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
M
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
1 ❑ New building Residential Nonresidential
2 ❑ Addition(11 residential, enter number 12❑ 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— — — — •-o 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 ------— — 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)
17 Other — Speci/y '�/�� �� 25❑ Public utility
7 ❑ Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP �3;,ze x 27 ❑ Stores, mercantile
8 ❑ Private (individual, corporation, 28 ❑ Tanks, towers
nonprofit institution, etc.) ' 29 _] Other — Speci/y
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 $J, cU.
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. D
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS O
m
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 O
35 ❑ Gas Will there be central air 52. Outdoors........................
36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44❑ Yes 45 ❑ No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — Specify Will there be an elevator? Full..........
54. Number of
46 D es 47 ❑ No bathrooms
Partial........
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'a a r "a ,,_''. 3% r� .,a; - `'=`r' 'fie, •'`�, 3;'„ `A201-
hereby certify that the proposed works !' , authorized by-the owner of record
and I have been authorized by the owner to make this application as his
authorized agent.
SIGNATURE OF AGENT-
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE lg
W j a DEPT. FILE COPY
CITY OF NORTHAMPTON BU I LD I r1lG 0<
NORTHAMPTONr MA. 01OW 17A - 158 PERMIT VALIDATION
DATE j]^i1 ��� 19 78 _ PERMIT NO. 92
APPLICANT KatherIng M. Cra.$8Y_ ADDRESS R= pi9y"gi(STREET)Pmad (CON7R'S LICENSE)
NUMBER OF
PERMIT TO Tniatel l Pool (`) STORY 1n9MUnd BWMT'nB 1>021 DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING �RA
AT (LOCATION) DISTRICT
(STREET)
a BETWEEN AND
o (CROSS STREET) (CROSS STREET)
rn
LOT
CL SUBDIVISION LOT BLOCK SIZE
u BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
ao
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
I ,,ry ; (TYPE)
REMARKS: ust�±-sue pool 16 x 32 - ---
AREA OR ESTIMATED COST $ 32000 FEEMlT 10100
VOLUME
(CUBIC/SQUARE FEET)
OWNER Be=ard J 0,016'ee,.ti', -- B
ADDRESS 53 Fox Farms Road, Florence, Ma. B
(Affidavit on reverse side of application to be completed by authorized agent of owner)