17A-244 (11) ZONING •
FRONT DISTRICT
USE
SIDE YARD SIDE YARD
REAR YARD
NOTES
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NOTES and Data — (For deportment use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, strut, city, and State ZIP code Tel. No.
Owner or yt f I
Lessee
l l t Bui Ider's
y, �Lm �G -t f�� -_I�/tt'✓ 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,OM application is auth rized gent and we agree to conform to all applicable laws of this jurisdiction.
Signatur o ap icant Address i Application date
00 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
Date D
Permit or Approval Check Obtained Number By Permit or Approval Check Obttaitned 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
VII. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building- Use Group
Permit issued 19
Building �0
Fire Grading
Permit Fee $ Live Loading
Certificate of Occupancy $ Occupancy Load
Ap by:
Drain Tile $
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
�$ �:� MASSACHUSETTS
OFFICE of the INSPECTOR of ,B ILDINGS
,at Page Plot APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
IMPORTANT - Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
ZONING
I• AT (LOCATION) r' DISTRICT<�: Ilh
LOCATION (N0.) (STREET) _r71
OF BETWEEN &I AND
BUILDING !) (C R OS S'ST R E E T) (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 ❑ Addition(If residential, enter number 12 ❑ One family 18 ❑ Amusement, recreational
Of new bousing units added, if any,
in Part D, 13) 13 ❑ Two or more family — Enter 19 Church, other religious
number of units— — — — —> 20 �❑ Industrial
3 �Alteration (See 2 above) 14 ❑ Transient hotel, motel,
21 ❑ Parking garage
4 �❑ Repair, replacement or dormitory — Enter number
5
El Wrecking (I/multifamily residential, of units ——————— — -- 22 Service station, repair garage
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13)
6 ❑ Moving (relocation) 16 ❑❑ Carport \ 24 ❑ Office, bank, professional
17 IX Other — Specify c`r Crr It 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,,,,,,,,,,,,,,,, 5 000 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 $ 5 COC
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 I
30❑ Masonry (wall bearing) 40 ❑ Public or private company 48• Number of stories............... ,
31 X Wood frame 41 ❑ Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior �G
32 ❑ Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
r —
34 ❑ Other — Specify 42 ❑ Public or private companMi 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 L7 Gas Will there be central air Nr n 52. Outdoors........................
36 L7 Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 L 1 Electricity 44 ❑ Yes 45 I❑ No 53. Number of bedrooms........I......
38 ❑ Coal `-
39 Other — Specify JU ]i( Will there be an elevator? Full. .....
54. Number of
46 ❑ Yes 47 D No bathrooms partial.,.....
Department of Building;:Inspections
212 Main Street
Northampton, Mass. 05"060 BUILDING Z '
17A - 244 PERMIT as
VALIDATION
DATE May 3, 104 PERMIT NO. 172
APPLICANT Barry Bouthilette ADDRESS 82 Lake Street 014156
IN 0.) (STREET) (CONTR'S LICENSE)
PERMIT TO Addition (_) STORY Back Porch NUMBER OF
DWELLING UNITS _
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION)
82 Lake Street ZONING
DISTRICT URB
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
ADDITION
XX-'V IS TO BE 10 ICU FT. WIDE BY 12 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS, permit to construct an addition onto existing back porch
AREA OR 120 sq. ft. 5,000.00 PERMIT 20.00
VOLUME ESTIMATED COST $ FEE
(CUBIC/SQUARE FEET)
OWNER Barry Bouthilette
ADDRESS
Lake St. , Plorence, Mass. 01060 B ILDI
8
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY PINK - ASSESSORS COPY