36-009 (5) Vill. ZONING PLAN EXAMINERS NOTES
DISTRICT
FRONT YARD
SIDE YARD
SIDE YARD
REAR YARD
NOTES
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NOTES and Data — (For department use)
s
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, stmt, city, and State ZIP code Tel. No.
1.
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
mak this application a is a orized agent and we agree to conform to all applicable laws of this jurisdiction.
Si u e of applicant �r Address Application date
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plan Review Date Plans Date Plans
Plans Review Required Check Fee Started BY Approved BY Notes
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Obttain d 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 FOR DEPARTMENT USE ONLY
Permit number /
Building Use Group
Permit issued 94 19�
Building � Fire Grading
Permit Fee $ 1
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
g+ �:� MASSACHUSETTS
$ OFFICE of th , INSPECTOR of B ILDINGS
,�, Page Plot APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IY, and IX. O
n •�',- ZONING -+`-�-_/-'-
I• AT (LOCATION) DISTRICT
LOCATION (NO. (STRE )
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
11. 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 New building Res'd ntial 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 ❑ Church, other religious
3 Alteration (See 2 above)
number of units- - - - 20 ❑ Industrial
❑
14 ❑ Transient hotel, motel, 21 C� Parking garage
4 ❑ Repair, replacement or dormitory - Enter number
5 ❑ Wrecking (if multifamily residential, of units ------- - --� 22 C_� 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
26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8 ❑ Private (individual, corporation, qt f 28 ❑ Tanks, towers
nonprofit institution, etc.) V1 X 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
processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement,.,...,.•....,,, i/���'' 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 $ Ll JtW,
111. 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,
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
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL t. TYPE OF MECHANICAL
35 ❑ Gas Will there be central air 52. Outdoors........................
36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44 ❑ Yes 45 i— No 53. Number of bedrooms.............
38 ❑ Coal
39 ❑ Other - Specify Will there be an elevator? Full..........
54. Number of
46 Yes 47 E] No bathrooms partial,,.....
DEPT. OF BUILDING INSPECTIONS BUILDING Z
! 212 Main Street 0 �C.' ��✓
Northampton, MA 01060 PERMIT 4 a.
36 -9 VALIDATION
DA T€ July 9, 9 86 P RMIT O. 370
APPLICANT Norman N Sawin ADDRESS orestslen Ur., More
(NO.) (STREET) (CONTR'! LICENSE)
PERMIT TO Addition (,1 STORY Inground Pool NUMBERNG OF
UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) 46 Forest Glen Dr. , Florence ZONING URA
(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 installation of an inground swimming pool
AREA OR VOLUME 512 sq. ft. ESTIMATED COST $ 4f000.00 PERMIT � 10.00
(CUBIC/SQUARE FEET) FEE
WK)OUM Same as Applicant
OWNER
ADDRESS ame as Applicant's eYILDIN
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY ■ PINK - AS SSORS COPY pOfp