17A-156 (5) VIII. ZONING PLAN EXAMINERS NOTES
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NOTES and Data — (For department use)
R9,� h
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — .'Vumber, street, rax, anti State ZIP coide Tel. No.
Owner or
Lessee
Bui Ider's `
2. �.. License No. �U
Contractor 7--Lo
r.2,n C,.
3. � Qr:
Architect or
Engineer
I hereby certif t the prop sed work is authorized by the owner of record and that I have been authorized by the owner to
make his app i a on as hi au o ized agent and we agree to conform to all applicable laws of this jurisdiction_
Signat a of app nt Address A licatio dat�e7
iC 3 d 7 b
T
00 NOT WRITE BELOW THIS LINE
V, LAN REVIEW RECORD — For office use
Plans Review Re uired 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
V11. VALIDATION
Building
Permit number 13
Building
Permit issued �A- r.:'�J r 19
Building
Permit Fee s
Certificate of Occupancy S
Ap,roved by_
Drain Tile � ����
Plan Review Fee i
TITLE
ti
� � �Ilassachltsetts
(office of the )1naptrtor of onirbings APPLICATION FOR
Page 7,14 Plot ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. Z
O
l• AT (LOCATION) � S/�/�
�� D STR CT
LOCATION (STREET) (('OF BETWEEN ! �` — v AND
BUILDING ROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
11. 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(1J residential, enter number 12 One family 18❑ Amusement, recreational
of Herr housing units added, if any, 13 Two or more family — Enter 19❑ Church, other religious
in Part D, 13) number of units— — — — ••->
3 (See 2 above) 20❑ Industrial
r14 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 240 Office, bank,professional
6 ❑ Moving (relocation)
17 EJ 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,
deportment store, rental office building,office building at industrial plant.
To be installed but riot 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 S ,
Ill. 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
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 ;K Wood frame 41 M 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
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed ....................... 0
35 ❑ Gas Will there be central air 52. Outdoors........................
36 Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44❑ Yes 45 K No 53. Number of bedrooms..............
38 ❑ Coal
39❑ Other— Specify Will there be an elevator? Full..........
54. Number of
46❑ Yes 47"`-,R No bathrooms
Portia[.......
hereby certify that the proposed work is authorized by the owner of record
and I have been authorized by the owner to make this application as his
authorized agent.
C
SIGNATURE OF `AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
DEPT: FILE COPY,
Z O
BUILDING 2 CL
CITY OF NORTHAMPTON PERMIT
VALIDATION
NORTHAMPTON, MASS. 17A - 156
DATE PAhrU&= 2. 197_ PERMIT NO. 13
APPLICANT Jonathan Wright ADDRESS 30 N Maple St., Florence
1 E
(CONTR'S LICENSE)
Al tpr RPRi denne NUMBER OF
PERMIT TO_ (�_) STORY Residence -DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING URA
AT (LOCATION) 69 FOR Farms Road DISTRICT
(NO.) (STREET)
rn BETWEEN Bridge Road AND Dead End
�o (CROSS STREET) (CROSS STREET)
01
LOT
D' SUBDIVISION LOT BLOCK SIZE
m
U
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION -
M
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
� (TYPE)
REMARKS: Renovate sunroom w/new Blass doors, new chimney, flooring, insulation
LL AREA OR ESTIMATED COST $ 4,000 FEE MIT $ 12.00
VOLUME
(CUBIC/SQUARE FEET)
OWNER pater ROUS BUI NG T
ADDRESS 69 Fox Farms Rd. BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)