17A-245 (7) Vill. ZONING PLAN EXAMINERS NOTES
REAR YARD
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NOTES and Data — (For department use)
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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 r1 �.2 ti
Lessee
Builder's
2. ELL License No.
Contractor 41 '
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 applicarif A dress aTion date
A p p I i c
0 0 NOT W R I T E BELOW T H I S L I N E
V. PLAN REVIEW RECORD For office use
Plan Review Date Plans Date Plans
Plans Review Required Check Fee Started By Approved By Notes
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL I$
OTHER i$
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Dote
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
Bui Idi:ng. Use Group
Permit issued 19
Building Fire Grading
Permit Fee $ Live Loading
Certificate of Occupancy $ Occupancy Load
Approved
Drain Tile $ � l�=�"
Plan Review Fee
TITLE
' CITY OF NORTHAMPTON
�. MASSACHUSETTS
$ OFFICE of the INSPECTOR of BUILDINGS
Page zzzr Plot APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: I, 11, 111, IV, and IX. O
!' ZONING ////�
I• AT (LOCATION)_ rS .,^ DISTRICTC.I�_
LOCATION (NO.) (STREET)
OF BETWEEN +, -.- AND ',w: 41
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 rn
m
1 ❑ New building Residential Nonresidential
2 ❑ Addition(If residential, enter number 12 One family 18❑ Amusement, recreational
of new housing units added, if any.
.n 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 El Wrecking (It 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 - 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,,,,,,,,,,,,,,,, �/� I) 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 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 C_� Electricity 44 ❑] Yes 45 ❑ No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other - Specify Will there be an elevator" Full..........
54. Number of
46 ❑ Yes 47 ❑ No bathrooms
Partial........
. y
DEPT. OF BUILDING INSPECTIONS BUILDING Z°
212 Main Street oa $10.00
Northampton, MA 01060 PERMIT
17A -
VALIDATION
X34-
DATE July 23, 2 PERtyj NO. 433
APPLICANT QGeorge Dastous ADDRESS (� S arms �t((QQ
(NO.) (STREET) (CONTR'S LICENSE)
Alteration Porch Roof NUMBER OF
PERMIT TO (_) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
Lake Streetq klor ence ZONING
AT (LOCATION) DISTRICT
(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 to put roof over open deck
AREA OR 800.00 PERMIT 10.00
VOLUME 55 sq. ft. ESTIMATED COST $ FEE $
(CUBIC/SQUARE FEET)
OWNER Dorothy Berube
ADDRESS
86 Lake Street, Florence BYILDIN
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY P'ixf' IiP