17C-305 (5) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
//./�
Name / y j^7 Mailing address — Number, street, city, any! State ZIP cod./je/ Tel. No.
DWnGr hC C� L(
c 0('a 6fv6lD 8 5 -fi4
Builder's
2. License No.
Contractor
3.
Architect or
Engineer
I hereby certify that the proposed work is authorized by the owjner 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 applicant Address Application date
00 NOT WRITE t# EL0W THIS LINE
V. PLAN REVIEW RECORD — For office use
Plan Review Date Plans Date Plans
Plans Review Required Check Fee Start td By Approved By Notes
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date
Permit or Approval Check Obtai ed 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
i
OIL BURNER WRECKING
OTHER OTHER
VII. VALIDATION
Building ! FOR DEPARTMENT USE ONLY
Permit number (G
Building Use Group
Permit issued Ca 19 549
Bui lding I Fire Grading
Permit Fee $ -�'1(�
Live Loading
Certificate of Occupancy $ Occupancy Load
Appc ved by:
Drain Tile $ �
Plan Review Fee
TITLE
CITY OF NORTHAMPTON
�. MASSACHUSETTS
OFFICE of they NSPECTOR of BUILDINGS
Page Plot —6 APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, I//, IV, and IX. O
ZONING
N
I• AT (LOCATION) "� �aH � L,�-7 ° DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN //1 �'�/J / AND ✓'�� "T •'t/:
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D -1
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
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,
in Part D, 13) 13 Two or more family — Enter 19 n Church, other religious
3 Alteration (See 2 above)
number of units— — — — —� 20 Industrial
�
14 Transient hotel, motel, 21 Parking garage
4 Repair, replacement or dormitory — Enter number r
5 Wrecking (If multifamily residential, of units ——————— — -- 22 ` Service station, repair garage
enter number of units in building in 15 C_� Garage 23 F Hospital, institutional
Part D, 13) ❑
16 Carport 24 Office, bank, professional
6 n Moving (relocation)
17 Other — Specify 25 Public utility
7 n Foundation only
26 School, library, other educational
B. OWNERSHIP 27 � Stores, mercantile
8 X Private (individual, corporation, 2B ❑ Tanks, towers
nonprofit institution, etc.) 29 n Other — Specify
90 Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food
f processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement•,•,,,,,,•,,..•. /COQ , !LQ 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....................... zv1P 0 /
u
b. Plumbing ...................... t
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 C j p company 48. Number of stories..............
y (wall bearing) 40 Public or private com an
31 Wood frame 41 Private (septic tank, etc.) 49. Total square feet 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 ......................
35 Gas Will there be central air 52. Outdoors........................
36 �] Oil L. RESIDENTIAL BUILDINGS ONLY
37 C) Electricity 44 l
r_ Y 45 i_ No
-.� es ---� 53. Number of bedrooms..............
38 [_�]( Coal )c� t�
39141 Other — Specify + Wil! there be an elevators Full..........
54. Number of
46 Yes 47 D No bathrooms
Partial......
,..
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y ...-,.
"4.4 s�
a DEPT. OF BUILDING INSPECTIONS BUILDING z°- ��• ��
! 212 Main Street O<
Northampton, MA 01060 PERMIT <a
17C XX - 305 VALIDATION
DATE Apri 1 211 19 ERMIT NO. 265 ownel
APPLICANT Ralph Healy ADDRESS es nU �t.
(N0.) (STREET) (C ONTR'S LICENSE)
PERMIT TO Addition (_) STORY
OF
One Family NUMBERNG UNITS
(TYPE OF IMPROVEMENT) N0. (PROPOSED USE)
1 ZONING
25 Chestnut Street UKIJ
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 for a 12' X 181 screened in porch in rear of existing dwelling
AREA OR VOLUME 216 SCl ft ESTIMATED COST 1 X200'00 FEEMIT � 10.00
(CUBIC/SQUARE FEET)
OWNER Same a(; Applicant BUI
ADDRESS Same as Upl icant' C BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK ^ ASSESSORS COPY pd P