43-077 (5) -, __.-____-._
9
Q DEPT. OF BUILDING INSPECTIONS BUILDING
1 P B"fJ 2J2 Main Street 04 L.. / G� . /
_-a Northampton, MA 01060 PERMIT """fffYYY
43 " 77 VALIDATION
DATE 1IIInP an 1q� P �,.,. ��,__
APPLICANT Gary Plocharski ADDRESS y/ UunU �fl,y OriveEWMIT NO. - Owner
IND.) STREET} ICOMTR'S LI CENS£I
PERMIT TO Above Ground Pool , y STORY One Family Dwelling NumDWEBEROF
NG (ANTS
(TYPE CFIMPROYEMENT) MO. (PROFOSCO USE)
57 Dunphy Drive 20M1XG SR
AT (LOCATION) DISTRICT
IRO., IETSCET)
BETWEEN FMD
(PAOSS STRE£i} tCROSS Crg#;T)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING 1$ TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS dt FOUNDATION
(TYPE)
REMARKS, permit for the installation of an above groun/d� pool
27' pdiameter by 4' height
VOLUME R 27' diameter ESTIMATED COST yl .2OO.yO PFF€EMIT $
� .I 11.GD
Music/sat/An lent)
OWNER Gary & Carol PIoCharski
ADDRESS 57 Dunphy Drive SY iD
WHITE - FILE COPY • GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSE SOBS COPY FY'1'dd-
_�,i'F_t • CITY OF NORTHAMPTON
(* fl
eMASSACHUSETTS
+ � OFFICE of the INSPECTOR of BUILDINGS
• limietv
_'<;' Page q�'� Plot APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT - Applicant to�complete all items in sections: I, II, III, IV, and IX. o
AT (LOCATION) ,,.-5f a4" /�pTnEadi�e ZONINlc
LOCATION
OF BETWEEN AND
BUILDING rEpa55 ErxEErl I<aoss Si P[E+I
LOT
SUBDIVISION LOT BLOCK SIZE
VI
II. TYPE AND COST OF BUILDING — All applicants complete Ports A - D A
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For 'Wreeking" most recent use m
lin
I New building Res' ennui Nonresidential
2 Addition(If residential, enter number I2 One family IS Amusement, recreational
of newhousing units added, if any.
in Part D, 13) 13 Two or more family - Enter 19 I Church, other religious
u
3I Alteration (See 2 above) number of hotel,
- - - 20Ir Industrial
14 ❑� Transient hotel, motel, 21 LI Parking garage
4I I Repair, replacement or dormitory - Enter number
5I Wrecking (if multifamily residential, of units - y 22 Hi Service station, reair garage
enter number of units in building in 15I I Garage 23 ❑ Hospital, institutional
Part 0, 13)
16 Carport 24 Office, bank, professional
6�1 Moving (relocation)
7 Foundation only17 c Other - Specify 25 t I Public utility
[[[YhhhG /� �p '/ 26 ^] Schaal, library, other educational
B. OWNERSHIP Lal^ 1 �%i4d'�2 2l I Stores, mercantile
��`-iV' 28 7 � Tanks, tow
6 Li nonprofit
oPrivate tiini.idual,utio tc.)corporation, 4f7+{7f el 29 F-1 Other - Specify
9 local
Public einstitution, etc.)
or illi y �
louai government) /�
C. COST (Omit cents) Nonresidential ibe in detail proposed use of buildings, e.g., load
processing plant, machine shop, laundry building at hospital, elementary 1
10. Cost of improvement $ ,,,,:i,4036. school, secondary school, college, parochial school, parking garage for I
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.
n the above cost
a. E lecrncol
b. Plumbing
c. Heating, air conditioning
d. Other(elevator, etc) —
i
11. TOTAL COST OF IMPROVEMENT $ v, 4.10 -
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
3I Masonry (wall bearing) 40fl m
. Public or private copany 48_ Number of atones
0
31 ❑ Wood frame 41 ❑( Private (septic tank, etc.) 49. Total square Feet of flo
all floats, based on exterior
32 Ti Structural steel dimensions
331 I Reinforced concrete H. TYPE OF WATER SUPPLY
34I I Other - Speedy 42 nPublic or private company 50- Total land areasq. 11
—
43 In Private(well, astern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed
351 I Gos Will there be central air 52. Outdoors
36 ❑ Oil conditioning' en _ L. RESIDENTIAL BUILDINGS ONLY
37 I` j Electricity 44 ❑ Yes 45 No 53. Number of bedrooms
38 I I Coal
39❑ Other-Spenly Will there be on elevator' { Full
54. Number of
46 [ I Yes 47', No bathrooms P r
IV. IDENTIFICATION — To be completed by all applicants
Moiling address Number. s met, rite and Starr ZIP code Tel. No.
'2(1 � :��-ciri 5;
Owner or ..1-" r-re; s,r
Less" EsAzy ALXk\ttKSK
Builder's
License No.
Contractor
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 oil applicable laws of this jurisdiction.
Signature of applicant Address Application date
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plan Reviews
Date Plans ByDate Plans
ByNotes
Required Check Fee StartedApproved
Plans Review
BUILDING -
$
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Dae
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
34?) FOR DEPARTMENT USE ONLY
Permit number
Building Uee Group
Permit issued (ie
l;� Fire Grading
Building /D oo
Permit Fee $ Live Loading
Certificate of Occupancy $ Occupancy Load
$ APpa:1 9 artai
.Drain Tile
Plan Review Fee $
TITLE
NOTES and Data — (For department use)
VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
IX. SITE OR PLOT PLAN — For Applicant Use
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