36-051 (2) Vill. ZONING PLAN EXAMINERS NOTES
SIDE YARD SIDE YARD
REAR YARD
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
owner or , �. ) O�60 �5{ / r
Lessee `j-76 D
1. 9 ^ ) � i t 1 LBcenserN0. 4
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.
Signature of applicant,- Address Application date
l�-
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
Permit or Approval Check Date Number By Permit or Approval Check Date Number B
Obtained Obtained 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 19
Building Fire Grading
Permit Fee
$ t2q' �
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
+ MASSACHUSETTS
$ e OFFICE of the INSPECTOR of BUILDINGS
Page Plot APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: I, 11, 111, IV, and IX. 0
I• AT (LOCATION) J2_ ZONING�O C n
DISTRICT ,
LOCATION r7(NO•) (STREET) (
BETWEEN C.L mot- AND
BUILDING (CROSS STREET) (CROSS TREET)
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(1/ residential, enter number 12 ® One family 18 ❑ Amusement, recreational
of new bousing units added, if any,
in Part D, 13) 13 ❑ Two or more fami ly - Fnter 19 [❑ Church, other religious
3 Alteration (See 2 above)
number of units- - - - -� 20 �❑ Industrial
❑ —
14 L_l Transient hotel, motel, 21 � Parking garage
4 ❑ Repair, replacement or dormitory - Fnter number
5 ❑ Wrecking (11 multifamily residential, of units ------- - -i 22 L station, repair garage
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13) -
16 ❑ Carport 24 I � Office, bank, professional
6 Moving (relocation)
17 Other - Specify 25 Public utility
7 Foundation only
26 School, library, other educational
B. OWNERSHIP 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
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.
7o be installed but not included If use of existing building is being changed, enter proposed use.
in the above cost L �'p,^ -I �_
a. Electrical....................... 1 F 4,1 61Y11 Il e+r'p-; CIc l
b. Plumbing .......................
Jq
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 ``ii
-- 48. Number of stories............ OII�
30 �❑ Masonry (wall bearing) 40j Public or private company
31 Wood Frame 41 Private (septic tank, etc.) 49. Total square Feet of floor area,
all floors, based on exterior
32 L_� Structural steel dimensions .....................
33 �J Reinforced concrete H. TYPE OF WATER SUPPLY
42',xj Public or P rivate company 50. Total land area, sq. ft. ..,
•
34 Other - S e ct f>
_
43 Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL
35 'L—, Gas Will there be central air 52. Outdoors........................
36 X Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 j Electricity 44 Yes 45,x. No 53. Number of bedrooms..............
38 ❑J Coal
39 'I Other - Specify Will there be an elevaror� Full..........
54. Number of
4IS o r ) Yes 47 N bathrooms
�-- Partial.......
-DEPT.-OF BUILDING INSPECTIONS BUILDING �° 4 11)V, 66
! 212 Main Street 0
Northampton, MA 01060 PERMIT <a
36 - 51 VALIDATION
DATE J Fi 19 PERMIT NO
APPLICANT Sundance Design A-
DDRESS ox Northamp on
(NO.) (STREET) (CONTR'S LICENSE)
Addition One Family NUMBER OF
PERMIT TO (_) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
12 White Pine Drive ZONING URA
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 the addition of a kitchen & dining area extension
VOLUME 160 so• ft. ESTIMATED COST $ 15,500.00 FEEMIT .� 64.00_
(CUBIC/SQUARE FEET)
OWNER David Neal aUIL0,
ADDRESS 12 White Pine Dr. , Northampton BY
WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY • PINK - ASSESSORS COPY Pl P
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