32C-219 (11) Vill. ZONING PLAN EXAMINERS NOTES
DISTRICT
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NOTES and Data — (For department use)
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IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or �//p�,D /1'rJ G!z 3 /V iii Fi 7' S''
Lessee
Builder's
2. 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.
Signatur ap 'cant Address Application date
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans B Notes
Fee Started y Approved y
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
Obtained Obtained 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 (o�
Bui Iding Use Group
Permit issued 19
Building Fire Grading
Permit Fee $
Live Loading
Certificate of Occupancy $ Occupancy Load
Appr ved by:
Drain Tile
9
Plan Review Fee
</ TITLE
CITY OF NORTHAMPTON
';� �` ! MASSACHUSETTS
$ e OFFICE of the INSPECTOR of BUILDINGS
Page13 Plot APPLICATION FOR
4a!V t
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. 0
/r'� yam- ZONING
I• AT (LOCATION)
/�{ �A Wi 0� S/ DISTRICT
LOCATION U t� IN 0.) `STREET) N i
OF BETWEEN /7C�[ 85V T AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT �Q nd0 OM
SUBDIVISION LOT BLOCK SIZE �0
Vr
II. TYPE AND COST OF BUILDING — All applicants complete Parts 'A — D ;0
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use 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 n Church, other religious
number of unzt's 20 Industrial
3 Alteration (See 2 above) 14 Transient hotel, motel,
21 �. Parking garage
4 E-1 Repair, replacement or dormitory - Pruer number 22 Service station, repay.
garage
5 [7 Wrecking (If multifamily residential, of units ------- - -i
L_ �
enter number of units in building in 15 C� Garage 23 Hospital, institutional
Part D, 13) 241 Office, bank, professional
16 l_1 carport
6 Moving (relocation) 25 Public utility
17 �� Other - Specify _
7 Foundation only 26 ,
L-_�l School library, other educational
B. OWNERSHIP 27 �- Stores, mercantile
8 Private (individual, corporation, 28 Tanks, towers S�0404C-��e
29 Other - Specify
nonprofit institution, etc.)
Specify S.L
9 n 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................ o(9 •OJ school, secondary school, college, parochial school, parking garage for
department store, rental office building, office building at industrial plant,
To be ir..stalled but not included If use of existing building is being changed, enter proposed use.
in the above cost
a. Electrical....................... It S&r JX lrsTm, , ofoo�
b. Plumbing ....................... /-1 jo <jf 4.bV-00 4
c. Heating, air conditioning..........
d. Other (elevator, etc.).............
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
I 1 _- 48. Number of stories................
30 u Masonry (wall bearing) 40 IL Public or private company
41 I Private (septic tank, etc.) 49. Total square feet of floor area,
31 n Wood frame - all floors, based on exterior
32 Structural steel dimensions .....................
33 Reinforced concrete H. TYPE OF WATER SUPPLY
34 L Other - Specify
42 F-1 Public or private company 50. Total land area, sq. ft. ...........
43 J Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 7 Gas Will there be central air 52. Outdoors........................
36 i Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 l Yes 45 No 53. Number of bedrooms..............
38 Coal
39 Other - Specify Will there be an elevator' Full..........
54. Number of
46 Yes 47 No bathrooms
C , � Partial,,.....
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