36-189 (13) ZONING •
FRONT DISTRICT
USE
SIDE YARD SIDE YARD
REAR YARD
NOTES
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IV. IDENTIFICATION - To be completed by all applicants
Name Mailing address — Number, stmt, city, and State ZIP code Tel. No.
Y G�
�r•
DofALP S Ic-L=-1 - Is Kr
Owner or
Lessee ON t� /• �
/r���Z
Builder's
/ License No.
Contractor IU ' o k O 1960 S73 -,
3.
Architect or
Engineer
I here Lertify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to
mak thi application as his authorize and we agree to conform to all applicable laws of this jurisdiction.
Si n r of applicant Address Application date
J 00 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 Date Number By Permit or Approval Check Date Number B
PP Obtained
Obtained y
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• / 19 � Use Group
Permit issued
�l Fire Grading
Building
Permit Fee $ • C1 " Live Loading
Certificate of Occupancy $ Occupancy Load
A ed by:
Drain Tile $ Jelevc
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
r e
MASSACHUSETTS
OFFICE of the INSPECTOR of BUILDINGS
Page �� Plot I/& APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items i sections: 1, I1, 111, IV, and IX. p
I• AT (LOCATION) ZONING DITR CT 3
LOCATION (N 0.) (STREET)
OF BETWEEN
AND
BUILDING (CROSS STREET) (CROSS STREET)
SUBDIVISION LOT _BLOCK LOT
SIZE
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For•'Wrecking" most recent use rn
M
1 ❑ New building Residential 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 C1 Church, other religious
number of units- - - - 20
3 ❑ Alteration (See 2 above) Industrial— ❑
14 ❑ Transient hotel, motel,
4❑ Repair, replacement 21 Parking garage
or dormitory — Enter number
5 ❑ Wrecking (it multifamily residential, of units ------- - .. 22 Service station, repair garage
enter number of units in building in 15'Z�<Garage 23 L❑ Hospital, institutional
Part D, 13)
6 ❑ Moving (relocation) 16 ❑ Carport 24❑ Office, bank, professional
7 El Foundation only
17 ❑ Other - Specify 25❑ Public utility
26❑ School, library, other educational
B. OWNERSHIP 27❑ Stores, mercantile
8 n1 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 of hospital, elementary
10. Cost of improvement,,,,,,,,,,,,,,,, S (��CJ 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.)............. L
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) 8. Number of stories................
9) 40 n Public or private company
31 Wood frame 41 n Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior
32 Structural steel dimensions .....................
33 L❑ 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
F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL 51. Enclosed .......................
35 Gas Will there be central air 52. Outdoors........................
36 OiI conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 �_ Electricity 44 _ Yes 45 !� No
38 Coal
53. Number of bedrooms..............
�_� jj�� -_
39 Other - Specify 14Ve/kj Will there be an elevator? Full..........
54. Number of
46 Yes 47 ❑ No bathrooms
Partial........
Department of Building Inspections
212 Main Street s_ BUILDING ~ 00 Northampton, Mass. OlObO 00
PERMIT
36 - 189 VALIDATION
DATE August 17, 19 83 PERMIT NO. 407
APPLICANT Donald Siegel ADDRESS 846 Burts Pit Road
(NO.) (STREET) (CONTR'S LICENSE)
One Family NUMBER OF
PERMIT TO Addition (_) STORY y DWELLING UNITS -
(TYPE OF IMPROVEMENT) NO. IPROPOSED USE)
846 Burts Pit ® Road ZONING SR
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. Addition of XX$x a garage and a breezway
15,500.00 PERMIT 60.00
AREA OR
VOLUME ESTIMATED COST $ FEE
(CUBIC/SQUARE FEET)
OWNER 17nnA1 d �+i POP1 BUI T
ADDRESS R46 Rurtc Pit Road BY
WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY ■ PINK - ASSESSORS COPY