31B-162 (13) ZONING •
DISTRICT
USE
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SIDE YARD SIDE YARD
REAR 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.
I.
Owner or O/D�Y>
Lessee l
}^ _ Builder's
2. � )14 License No.
Contractor /
3.
Architect or
Engineer
I hereby certify that the proposed work is authorized by the o�ner of record and that I have been authorized by the owner to
make this application as his authorized agent and we agree toj conform to all applicable laws of this jurisdiction.
Signature of applicant Address Application dote
D0 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date tans B Date Plans By Notes
Fee Star y ed Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Permit or Approva I Check Obtai ed Number y Permit or Approva I Check Date Number By
Obtained
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
i
VII. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Bur(ding ,9 Use Group
Permit issued
Building Fire Grading
Permit Fee $ la�Ud
Live Loading
Certificate of Occupancy $ Occupancy Load
$ App d by:
Drain Tile
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
MASSACHUSETTS
r r
$ OFFICE of th INSPECTOR of BUILDINGS
v�
, Page Plot — APPLICATION FOR
INSPECTOR
ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. 11 O
ZONING ( If("1^1
I• AT (LOCATION) ���
ZONING C 1
LOCATION (NO.) (STREET)
OF BETWEEN AND
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 m
m
1 FKI New building Residential Nonresidential
2 ❑ Addition(If residential, enter number 12 ❑ One family 18 ❑ Amusement, recreational
of new bousing units added, if any,
in Part D, 13) 13 ❑ Two or more family — Enter 19 ❑� Church, other religious
number of units— — — — --> 20 ❑J Industrial
3 ❑ Alteration (See 2 above) 14 l
l
h
Transient hotel, mote ,
❑ 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
5 �❑ Wrecking (If multifamily residential, of units ------- — 22 L� 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)
7 ❑ Foundation only 17 ❑ Other — Specify 25 ❑❑ Public utility
Gi Or 26 ❑ School, library, other educational
B. OWNERSHIP C� ^ iQ 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
! r processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement,,••,.•••••••,•, 6 J 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, r /
all floors, based on exterior
32 ❑ Structural steel dimensions .....................
33 L❑ 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 'i`I No 53. Number of bedrooms..............
38 ❑ Coal
39 Other — Specify 7)n .L Will there be an elevator? Full..........
54. Number of
46 ❑ Yes 47 ❑ No bathrooms
Partial.......
Department of Building Inspections
212 Main Street BUILDING Z /
Northampton, Mass: OO< '
�" PERMIT
31B - 162 VALIDATION
DATE
February 15, )y 84 PERMIT NO. 55
APPLICANT Mary S. Shaub ADDRESS 159 Elm Street Owner
(NO.) (STREET) (CONTR'S LICENSE)
New Building UMBER OF
PERMIT TO g (_) STORY Tool Shed DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION)
159 Elm Street — IS ZONING URB
T
(N0.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE 8 FT. WIDE BY 10 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS permit to put up a new 8' by 10' �l shed.
:
AREA OR 80 sq. ft. ESTIMATED COST $ 1,465.00 FEEMIT $ 10.00
VOLUME
(CUBIC/SQUARE FEET)
OWNER Mary S. Shaub
1 9 Elm St. , Northampton, Mass. 01060 BUILD
ADDRESS
WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY • PINK - ASSESSORS COPY