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FRONT . ,
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REAR YARD
NOTES
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NOTES and Data — (For department use)
NOWi
i
i
IV. IDENTIFICATION — To be completed by all applicants
A'
Name Mailing address — Number, street, rite, and State ZIP code T.I. No.
1. r -i }
Owner or u t :-/ f t` IC,� C,
Lessee
Baca tldeir's
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
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans By Date Plans By Notes
Fee Started Approved
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check obttaaineed 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
Permit number
Building -19 �
Permit issued .c, � 7
Building
Permit Fee $ --;7 �.
Certificate of Occupancy
Approved by:
Drain Tile
Plan Review Fee
TITL
O� o
� � flGlsss�tdptsetfs
�a t Office of t4v �nsptrtor of Auilbrilgs APPLICATION FOR
Page� Z—Plot ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. p
I•
ZONING AT (LOCATION) ,( -(' {.. l C�a
DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
SUBDIVISION LOT BLOCK
LOT
N
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
m
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use (n
1 [ ' Iew building Residential Nonresidential
2 F-1 Addition(If residential, enter number 12 One family 18 Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 F_� Two or more family -• Enter 19 Church, other religious
3 [:] Alteration (See 2 above)
number of units- -- - - > 20 Industrial
�•
14 D Transient hotel, motel, 21 P
� arking garage
40 Repair, replacement or dormitory - Enter number
5 ❑ Wrecking (If 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 F-1 Moving (relocation)
17 [_1 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•,••••,,,....... ;^'y '' 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 $ - `I •4'�''
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. D,
x
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS 17
m
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 F-1 Structural steel dimensions ......... /
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY 17 iyX
42 Public or private company 50. Total land area, sq. ft. ........... 'i_2
34 Other - Specify J✓J P P y
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ...................... r
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL O
35 F-1 Gas Will there be central air 52. Outdoors........................ t
36 ®'"Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 [:] Electricity 44 D Yes 45 [�No 53. Number of bedrooms.............. 3
38 F-1 Coal
39 0 Other - Specify Will there be an elevator? 54. Number of Full..........
46 [:] Yes 47 [j o bathrooms
Partial....... �`
I hereby certify that the proposed work is authorized dy the owner-of'record-
and I have been authorized by the owner to make this application as his
authorized agent.
e
SIGNAtORE O V AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
CITY OF NoRTHANiPTON Z o
DEPT. FILE COPY
�
i BUILDING
NoRTa ! wN, mA. o1o6o 3 F7 PERMIT
VALIDATION
DATE April 24, ig 78 PERMIT NO. 124
APPLICANT Theodore Towne ADDRESS 53 Pat Hill Rd., N'ton.
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO New Residence ( I ) STORY Residence DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING SR
AT (LOCATION) R't 66 WeathaW±T Rnad DISTRICT
(NO.) (STREET)
a BETWEEN AND
m (CROSS STREET) (CROSS STREET)
IM
LOT
a SUBDIVISION LOT BLOCK SIZE
m
U BUILDING IS TO BE 74 FT. WIDE BY 28 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
to
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
I (TYPE)
Ir
IL REMARKS: C'.nnAtrUQ't GnRAfAndlp residence
AREA OR VOLUME 135 ESTIMATED COST $ 2 FE EMIT .� 7+.00
(CUBIC/SQUARE FEET) '
ti
OWNER m3patinra TflT.11"IA
BUIL�4NG D T.
ADDRESS 53 Park Hill Rd, , N/ton. BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)