28-062 (5) ZONING ,
FRONT DISTRICT
- .
SIDE • . SIDE YARD 16
REAR YARD
NOTES
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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 — A'umbc°r. .titnc/, rr(>, Ana/ Snnr ZIP code Tel. No.
Owner or
Lessee
(.f�vw Builder's
L
' 1�Q/ License No.
Contractor
Architect 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.
Signal of applicant Address p Application date
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans B Notes
9 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
VII. VALIDATION
Building
Permit number
Building
Permit issued J�2C-1�' l ig 77
Building /,9` o
Permit Fee $
Certificate of Occupancy
prove by:
Drain Tile
Plan Review Fee —
TITLE
O� O
(rxty of Nort4ampton s�j
$ d �Tilsss�[clplsetts
Office of the Ynoptrior of `Puilbings
APPLICATION FOR
Page��Plot�'�� ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT - Applicant to complete all items in sections: 1, 11, 111, IV, and IX. p
ZONING C<—
AT (LOCATION)
/W.a/ DISTRIC
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
II. TYPE AND COST OF BUILDING - All applicants complete Parts A - D m
A. TYPE 0 IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use M
1 New building Resi4enpel Nonresidential
2 u Addition(It residential, enter number 12 One family 18 ❑ Amusement, recreational
of new housing units added, if any, 13 F-1 Two or more family — Enter 19 ❑ Church, other religious
in Part D, 13) number o units — — — -->
J 20 ❑ Industrial
3 ❑ Alteration (See 2 above)
14 Transient hotel, motel,
21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
5 F—] Wrecking (If multi family residential, of units ——————— — -i 22 Service station, repair garage
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13) 24❑ Office, bank, professional
6 Moving (relocation) 16 ❑ Carport
❑ 17❑ Other — Specify 25 ❑ Public utility
7 ❑ Foundation only 26 ❑ School, library, other educational
B. OWE HIP _ 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
"I processing plant, machine shop, laundry building at hospital, elementary
S10. Cost of improvement................ 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 ..................... X p"C
c. Heating, air conditioning.........
d. Other(elevator, etc.)............
� 1
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. D
0
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS M
48. Number of stories...............
30❑ so nry (wall bearing) 40 ❑ Public or private company 31 od frame 41 ❑ Private (septic tank, etc.) 49. Total square Feet n floor area,
all floors, based on exterior
32❑ Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
Public or private company 50. Total land area, sq. ft. ...........
42
34❑ Other — SpeciJy ❑ p
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ....................... r
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL O
35 ❑ Gas Will there be central air 52. Outdoors........................
36 ❑ Oil conditionin;? L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44 ❑ Yes 45 ❑ No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — Specify Will there ke an elevator? 54. Number of Full..........
46 ❑ Yes 47 ❑ No bathrooms Partial........
.,. ,,..E
I 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.
SIGNATURE OF AGENT 0"
F
ADDRESS
(NUMBER) (STREET) (CITY) "
APPROVED BY TITLE
DATE T9
— F DEPT. FILE COPY
zC)
CITY OF NORTHAMPTON BUILDING �a
NORTHAMPTON, rte. 28-62 PERMIT VALIDATION
DATE ontober j4. 19 77 PERMIT NO. 507
APPLICANT Donald J- 'A" Q ADDRESS 612 Ry8.Ti Road
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO � � Bldg (_) STORY Storage DWELLING UNITS
(TYPE OF IMPRO MENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 619 Ryan Read -- 0IISTR CT SR
(N0. (STREET)
rn BETWEEN AND
'a (CROSS STREET) (CROSS STREET)
w
LOT
a. SUBDIVISION LOT BLOCK SIZE
m
a
U
O. BUILDING IS TO BE FT. WIDE BY 30 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
M
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
0:
IL REMARKS: - Aux- Building
AREA OR
VOLUME ESTIMATED COST $ i00.00 FEEMIT O 00
(CUBIC/SQUARE FEET)
OWNER Donald J• Bur-do BU
ADDRESS 6199 Rv= Road, Northa=ton BY 4ioe
(Affidavit on reverse side of application to be completed by authorized agent of owner)