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36-131 (8) Vill.-ZONING PLAN EXAMINERS NOTES DISTRICT FRONT YARD SIDE YARD SIDE YARD REAR YARD NOTES OR—PLOT .. 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IDENTIFICATION — To be completed by all applicants Name �//� Mailing address — Number, street, ciitv,`and State ZIP code Tel. No. Owner or 0• — ^'q-�` ' v 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. Signature of applicant Address Application date AP . (I—L" — 1 DO NOT WRITE BELOW THIS LINE V. PLAN REVIEW RECORD — For office use Plans Review Required Check Plan Review Date Plans B Date Plans Fee Started y Approved By Notes BUILDING $ PLUMBING $ MECHANICAL $ ELECTRICAL $ OTHER $ VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Permit or Approva I Check Date Number By or Permit Approval I Check B Date Number Obtained pp 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 �f FOR DEPARTMENT USE ONLY Permit number �. Building C�G:f.�l l Z... Use Group Permit issued 19 Bur(ding ` O Q � Fire Grading Permit Fee $ Live Loading Certificate of Occupancy $ Occupancy Load o d by: Drain Tile $ Plan Review Fee $ TITLE CITY OF NORTHAMPTON g. MASSACHUSETTS r • $ OFFICE of the INSPECTOR of BUILDINGS Page w3G -Plot APPLICATION FOR ZONING PERMIT AND INSPECTOR BUILDING PERMIT z IMPORTANT — Applicant to complete all items in sections: I, 11, 111, IV, and IX. C) //JJ ZONING a,q I• AT (LOCATION) DISTRIC __ 11 LOCATION (N0•) (STREET) OF BETWEEN AND BUILDING {CROSS STREET) (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 rn 1 ❑ New building Residential Nonresidential 2 D Addition(If residential, enter number 12 X One family 18 Amusement, recreational of new bousing units added, if any, in Part D, 13) 1371 Two or more family - Enter 19 � Church, other religious number of units- - - - --> 20 Industrial 3 F-1 Alteration (See 2 above) 14 E] Transient hotel, motel, 21 Parking garage 4 Repair, replacement or dormitory - Enter number 5 Wrecking (If multifamily residential, of units ------- - -- 22 L� 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) 25 Public utility 17 � Other - Specify 7 Foundation only � 26 School, library, other educational B. OWNERSHIP 270 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................ -"Q'• 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 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 30❑ Masonry (wall bearing) 40 Public or private company 48. Number of stories.............. 31 g Wood frame 41 Private (septic tank, etc.) 49• Total square feet of floor area, all floors, based on exterior 32F--] 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 I. TYPE OF MECHANICAL 35 Gas Will there be central air 52. Outdoors........................ conditioning? 36 ❑ Oil L. RESIDENTIAL BUILDINGS ONLY 37 C) Electricity 44 n Yes 45ljt No 53. Number of bedrooms.............. 38 Coal j 39 n Other - Specify Will there be an elevators 54. Number of Full.j j....... - 46 Yes 471%_JA No bathrooms Partial........ ti DEPT. OF BUILDING INSPECTIONS BUILDING Z° ! 212 Main Street 0 ' f Northampton, MA 01060 PERMIT 36 - 1310 VALIDATION DATE April 11, 19 86 PERMIT NO. 151 APPLICANT Oscar Johnson ADDRESS 295 Brookside Circle (NO.) (STREET) (CONTR'S LICENSE) NUMBER OF PERMIT TO New Building (`) STORY One Family DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) 295 Brookside Circle 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: perrnit for a new garage and breezway AREA VOLUME ESTIMATED COST $ 2,500.00 FEE MIT $ lo_oo (CUBIC/SQUARE FEET) 1 � a Same as Applicant - -1 OWNER BUIL01 ADDRESS BY WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY ■ PINK - ASSESSORS COPY pop