35-178 (5) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
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NOTES and Data — (For department use)
Lei q x 'oiL& ''
—A-eA,
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or
Lessee
Builder's
2, 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 all applicable laws of this jurisdiction.
Signat of app 'cant Address Application d
(� 7
DO NOT WRITE B E L W THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans By Notes
Fee Started y Approved
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
II. VALIDATION
Building a //r� FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued Q,' T9
Building f� / J� Fire Grading
Permit Fee $r !/ '1 �/ 1 Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by::,,�
Drain Tile $
Plan Review Fee $ �f
TITLE
CITY OF NORTHAMPTON
MASSACHUSETTS
r ;
OFFICE of the INSPECTOR of BUILDINGS
Page— `7 Plot ` APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
a
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
K(','° j'� _ .r ZONING A \�
I• AT (LOCATION) J �l�f_ DISTRICT" -_
LOCATION IRO') (STRECT)
OF
BUILDING BETWEEN (CROSS STREET) AND (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
1 ❑ New building Residential Nonresidential
2 �Addition(lf 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 ❑ Church, other religious
number of unit's- - - - •� 20 ❑ Industrial
3 ❑ Alteration (See 2 above)
14 ❑ Transient hotel, motel, 21 �� Parking garage I
4 ❑ Repair, replacement or dormitory - Enter number
5 ❑ Wrecking (1l multifamily residential, of units ------- - -i 22 ❑ 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)
17 ❑ Other - Specify 25 ❑ Public utility
7 ❑ Foundation only / r h
26 ❑ School, library, rt.er educational
B. OWNERSHIP t r 27 Stores, mercantile
/' 28 ❑ Tanks, towers
8 �':f rivate (individual, corporation, j
29 oca Other - S
nonprofit institution, etc.) ❑ Specify i
9 ❑ Public (Federal, State, or
local government) -
C. COST (Omit cents) Nonresidential - Describe in detail proposed use of buildings, e.g., food
7 processing plant, machine shop, laundry building at hospital, elementary
10. 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. I
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
48. Number of stories............
30❑ Masonry (wall bearing) 40 [_-] Public or private company
49
31 Q,Wood frame 41 Eq-Private (septic tank, etc.) • 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 Rublic or private company 50. Total land ores, 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 conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 C_j Electricity 44 ❑ Yes 45 \No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other - Specify Will there be an elevator? f Full..........
54. Number o
46 F� Yes 47 ❑-No bathrooms
Partial.......
DEPT. @F-SUItDING INSPECTIONS BUILDING Z° /0 . 60 212 Main Street '<
Northampton, MA 01060 PERMIT Qa
35 - 178 VALIDATION
DATE June 95, PERMIT No. 41Q
APPLICANT Robert Mimitz ADORES 8 ine a ley Road Owner
(N0.1 (STREET) (CONTR'S LICENSE)
Addition deck NUMBER OF
PERMIT TO (,) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT► NO. (PROPOSED USE)
AT (LOCATION) 8 Pine Valley Road ZONING SR
01STR ICT
(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 the addition of a 121 x 12' deck
AREA OR 144 sq. ft. 350.00 PERMIT 1 0.00
VOLUME ESTIMATED COST $ FEE s
(CUBIC/SQUARE FEET)
Same as Applicant
OWNER
ADDRESS Same as Applicant's B
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY PINK - ASSESSORS COPY P1Rf` P