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36-247 (2) o o > z ' r.L ►�- W 0. ; FT. Otte . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z M0 IA 0 0 C r � 0o r M0 0Z NOTE:IN ORDER THAT THIS APPLICATION MAY BE ACCEPTED,THE DATA CALLED FOR BELOW MUST BE SO SET FORTH THAT WE CAN DETERMINE FROM THE APPLICATION AND THE ACCOMPANYING PLANS WHAT THE EXISTING CONDI- TIONS ARE AND WHAT THE FUTURE CONDITIONS WILL BE. Plot Plans and Plans,must be filed with this application before a permit be granted. Zone APPLICANT NOT TO FILL IN SPACES ABOVE THIS LINE Application for a Dwelling Permit a Northampton,Mass. . . �5�n 3 . '� . . 19 . . . . .Telephone No. . . . J��.�. ".,�5,�./. . . . . . . . . . . . . 7b the Supt.of Buildings: Application for a permit to build is hereby made according to the following:- 1. Location,Street and No. .. .y . . . S�'f a `�. . . .L.'+Nf . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Lot No. . . . . . . . . . . 2. Nearest cross street . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Size of lot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Owner's name . iJim. . . iCt. . . . . . . . . . . . . . . . . . . . Address . . .�/. .5f'Ni t-: .(�E.. . . . . . . . . . . . . . . . . 4. Architect's name . . . . . . . . . . . .`.."_". . . . . . . . . . .. . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Builder's name . . ir'.! . . ?. . . . . . . . . . . Address . =3L21[? . .�Cy#��: *�. . . .� . . . . . . . . . Mass. Construction Supervisor's License No. . . . .0_.5a-7 4 y . . . . . . . . Expiration Date . . . . . 6. Use of Building:One-family . . . . . . Dom- . . . . . . . . . Two-family . . . . . . . . . . . . . . . . . . . . Other . . . . . . . . . . . . . . . . . . . . 7. Number of rooms in each family unit: . . . . . . . . . . . . . . . . . . . . . . . Number of Bathrooms . . . . . . . . . . . . . . . . . . . . . . . 8. Is there a garage attached? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of building . . . . Square footage . . . . . 4'Ai . . . . . . . . .. . . . . . . . . . . . . . . . 10. Number of stories . . . . . . . /. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Distance from finished grade to high point of roof . . . . . `�-3. . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . .. . . . . . 12. Type of construction . . . . . . .7--.t-.i . . f?w , .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . O 1` 13. Distance from building to street line in feet . . . . ✓�i✓ . . . . . . . . . . . . ., . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . 14. Distance from building to side lot lines in feet:Left . . . . Alk,. . . . . . . . . . . . . . . . Right . . . . . . . . . . . . . . . . . . . . . 15. Distance from building to rear lot line in feet . . . . . .CO._�. . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16. Is a plot plan being filed with this application? . . . . ", . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . 17. Species of framing lumber:DF . . . . . . . . . . . . . . . .. . . . Spruce . . . . . .rte. . .—. . . . . . . . . Other . . . . . . . . . . . . . . . . . . . . 18. Are all structural conditions noted on drawings? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. Nature of land upon which the structure will be erected: Natural . . . . .�0.--: . . . . . .. . Filled . . . . . . . . . . . . . . . . . . . 1� 20. Depth of basement or cellar floor below finished grade . . . . . . . . .;� z.,. . . . . . . . . .. . . . I . . . . . . . . . . . . . . . . . . . . . . 21. Material of foundation walls . . . . (?dt12 12. . . . .00! 42 .. . . . . . . . . . . . Thickness in inches . . . . . . . . . . . . . . . 22. Type of roof: Flat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pitched . . . . . I.?-:kt .,. . . . . . . . . . . . . •s 23. Material or roof covering . . . . .tZ.. . . .� x . . . . . .�s?~ . . . .t3/ �1]`t !�+�C . . . t�?N .4r�J. . . . . . . . . . . . . . 24. Method of heating . . . . .N. n+ .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25. Will the building conform to the Building and Zoning Ordinances? . . . .`44. . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26. Septic Tank? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . City Sewer? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27. Construction within 100 ft.of wetlands? . . . . . . . .t�.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28. Construction within 100 year flood plain? . . . . . . . '" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29. Estimated cost:Total $ . . . ./0t. .08 7,. .` . . . . . . . . . . . . . . . . . No building or structure which is erected or altered,shall be used,in whole or in part,for any purpose until a certificate of occupancy is issued by the Building Inspector. The undersigned certifies that the above sta ments are true to the best of his knowlednd belief. Tigna c'?!?. . . . Lam. .Z-. . . . . . . . . . . . .1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . u re of Contractor Signature of responsible applicant WRITTEN DESCRIPTION OF WORK TO BE DONE C�tvs.rnuc �:. . . .«. . . . .Z.Z'/Z. .2.y . . . . . .E .E . . . .4!V ? . .0 . . �> 04.A. .N.C�-. . .Iz3 fdrVJ9. . . .Zf . ' /. d-co t j)LL s rOt` . . . . . . � . . . j yt . . �(. . . . .5y �[[ +K. . .cx. . . .�UYr����►ra/.hrr. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . •PERMIT APPLICATION CHECK LIST PAGE PLOT ''4 "ZONE YES NO DATE °J 1 . ZONING FORM APPLICATION �Z Q 2 . PERMIT APPLICATION U 3 . OWNER OCCUPANT STATEMENT LIC .# -IF NOT 4 . 3 SETS OF PLANS /PLOT PLAN 5 . NEW CONSTRUCTION 6 . CURB CUT 7 . WATER AVAILABILITY FORMS 8 . REMODELING INTERIO 9 . ADDITION 10 . ACCESSORY STRUCTURE 11 . SIG AWNING 12 . PERMI FE - CHECK ONLY - MONEY ORDER 13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE 14 . UNDER SECTION 127 - CMR 780 15 . FORM A 16 . FILL COMMENTS : a 'n( b � � I Y j I � I I � i i i � 1111' I li 1 � q CAI ±',<►-�� �. ����� � j � � ��� l i �„� 1 �� - .,;� ;' _ � � �I ,� -- �� �'�' .� G 1� t ' 1 1 I I R w�, . 4wt�ywJ��l i J Date Filed �/ l3 File No. ZONING PERMIT APPLICATION (§10 . 2) 1. Name of Applicant: Address : r- r y jA p 0t 2 . Owner of Property: . 1 Address : y/ �SP�evc ,� d� Telephone : - 3 . Status of Applicant: Owner Contract Purchaser Lessee Other (explain: 4 . Parcel Identification: Zoning Map Sheet# Parcel# --,2jvzr Zoning District(s) (include overlays Street Address _ Required 5. Existinqq Proposed by Zoning Use of Structure/Property 2.� (if project is only interior work, skip to #6) Building height C,;Z" '-0" %B1dg. Coverage (Footprint) Setbacks - front - side L: i R: L: R: Z, - rear Lot size Frontage Floor Area Ratio topen Space (Lot area minus building and parking) Parking Spaces Loading Signs Fill (volume & location) 6. Narrative Description of Proposed Work/Project : (Use additional sheets if necessary) a tt_ � Z / ,y t gib eyJ � ��nfl"f -cn�r✓r��an,�r�/ 7 7. Attached Plans : Sketch Plan Site Plan 8 . Certification : I hereby certify that the information contai ed herein is true and accurate to the best of my knowled Date: ] ��,�L�3, lgl3Applicant's Signature: let) r THIS SECTION FOR OFFICIAL USE ONLY: Approved as presented/based on information presented Denied as presented--Reason: Special* Permit and/or Site Plan Required: Finding Required: Variance Required : Signature of Building Inspector `J Date NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits from tho Board of Health, Conservation Commission, Department of Public Works and other applicable permit granting authorities. ic'?"L am fir. 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