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NOTES and Data — (For department use) f 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,,..... ►x 'C C C eD R n < C CL CL eD D C74 eD CD rD `C < C R x o �• eD 'C•. to C c-+ w A c+ i OQ• v• ? �"' CA C `• o d O CL r+ C ? 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