23D-037 (15) ,File#BP-2004-0252
APPLICANT/CONTACT PERSON DIVERSIFIED CONSTRUCTION SERVICES LLC
ADDRESS/PHONE P 0 Box 168 (413)253-2798
PROPERTY LOCATION 11 ORMOND DR
MAP 23D PARCEL 037 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid ",
Building Permit Filled out /
Fee Paid
Typeof Construction: ADD 8 X 24'ADDTION TO HOUSE TO EXPAND 2 EXISTING BEDROOMS
New Construction
Non Structural interior renovations _
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 030787
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN O"; ,' . PPLICATION BASED ON
INFOISIATION PRESENTED:
Approved Additional permits required(see below, •
PLANNING BOARD PERMIT REQUIRED UNDEi
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR_ _ Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDL.
Finding Special Permit _ Variance*
Received&Recorded at Registry of Deeds 1- ,iof Enclosed
Other Permits Required:
Curb Cut from DPW Water Av. Sewer Availability
Septic Approval Board of Health 11 Water Potability Board of Health
Permit from Conservation Commission . .rmit from CB Architecture Committee
Permit from Elm Street Commission
Signs of Building O icial Da e
Note:Issuance of a Zoning permit does not relieve a app'ie :, burden to comply with all zoning
requirements and obtain all required permits from Bo:,: . . .oath,Conservation Commission,Department
of public works and other applicable permit granting a ;.s.
*Variances are granted only to those applicants who meet :t standards of MGL 40A.Contact Office of
Planning&Development for more information.
City of Northampton S atusof P rm�t " :"
Building Department Curb1C �,QgVewa ~._ z1_
212 Main Street Sewer-ISe® i
Room 100 Wa er/We[l= vajJab t` �—t.,- -
Northampton, MA 01060 TwaSets'of c rat Pa
• 2s�s
phone 413-587-1240 Fax 413-587-1272 Piot/Site`P a►iK
rvSpeci
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE'INFORMATION
1.1 Property Address: • Tills section to be completed by office
i/ ��J�2lQrf ,41
Map } t' Lot Unit
yf 7/-aZ I _� Zone Overlay District
(/� �? Elm St. District - CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED-AGENT
2.1IO�wner of Record:/ • �j1
.A. // Or' ctne- -�v`-4 r//.ehc o/c772
Name(Print)
l �J Current Mailing Adc d7d�
V Flo — 2 Up
Telephone
Signature
2.2 Authorizedt Agent:
�/ 6 /Yqr �_ �/ t d F /s e/c i-er;4fr-v1,. A
Name(Print) Current Mailing Address:
Ak
Telephone
SECTION 3 - ESTIMATED CONSTRUCTION="COSTS..
Item Estimates Cost(Dollars)to be Official Use•Only
completed p by permit applicant
1. Building (a) Building Permit Fee
2. Elec,rical (b) Estimated Total Cost of
Construction.from:(6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) - ..3d, a 0 Check Number
This Section For Official Use Only
•
Building-Permit-Number: Date Issued
•
�(Signature:
Building Commissionerllnspector of Buildings Date