32C-267 Vill. ZONING PLAN EXAMINERS NOTES
DISTRICT
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
Im
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, stmt, city, and State ZIP code Tel. No.
'' Z �Owner or 'WAI -1 S S ./ (J /n
Lessee IV04-7-1y 1'-14
Builder's
2• IN IC.H A17L License No. 1%
Contractor
O
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.
Signature of applican Address APPlication dote S O t�dC /°fv't—� j7i v /
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
Permit or Approval Check
Date Number B Permit or Approval Check Date Number B
Obtained y PP N b
Obtained Y
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 I 1 19 _
Building Fire Grading
Permit Fee $_ ^'j .�
Live Loading
Certificate of Occupancy $ Occupancy Load
Approve y:
Drain Tile $
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
�. .� MASSACHUSETTS
3 OFFICE of the INSPECTOR of BUILDINGS
Page al= Plot 4(0 APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT(/,, Applicant to complete all items ink sections: I, II, 111, IV, and IX. 0 ZONING
(• AT (LOCATION) v 1(„L'I/1 M -S ✓ �— DIISTR CT(
LOCATION (RO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
Vr
11. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
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❑ Church, other religious
number of units- - - - -0- 20 Industrial
Transient hotel, motel
3 Alteration (See 2 above) 14 ,
❑ 21 �� Parking garage
4❑ Repair, replacement or dormitory - Enter number
5 ❑ Wrecking (If multifamily residential,
of units ------- - -- 22 Service station, repair garage
enter number of units in building to 15 ❑ Garage 23 Hospital, institutional
Part D, 13) 16 Carport
24�� Office, bank, professional
❑
6 ❑ Moving (relocation)
17 Other - Specify AJt'T-"--j 25 Public utility
7 ❑ Foundation only 26 School, library, other educational
B. OWNERSHIP voOfr &,_A4 A_6 .ue_eT 1 27 Stores, mercantile
8 Private (individual, corporation, 28 ❑ Tanks, towers
nonprofit institution, etc.) M 29 ❑ Other - Specify
9 Public (Federal, State, or
local government)
C. CAST ( zt C/C�s)� Nonresidential - Describe in detail proposed use of buildings, e.g., food
y processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement................ - 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 t 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 $
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
48. Number of stories...............
30 L] Masonry (wall bearing) 40 Public or private company
41 �❑ Private (septic tank, etc.) 49. Total square feet of floor area,
31 �( .Wood frame p all floors, based on exterior
32 ❑ Structural steel dimensions .....................
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY
50. Total land area, sq. ft. ...........
34 ❑ Other - Specify 42 Cr�"Public or private company
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 ❑ Gas Will there be central air 52. Outdoors........................
36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 f Electricity 44 ❑ Yes 45 No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other - Specify Will there be an elevators b Full..........
- 54. Number of
bathrooms
46 , Yes 47 ' No Partial........
-1 ne
uo
CANARY
F 1 ELI) COPY ■
PppRE55
FILE COPY • GREEN
WNI�E
AND
(CROSS STREET) (
i
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
! r
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
;
(TYPE)
REMARKS rIiit L l §l l.;oii _.i.-+ o'I d( I .S � 6: i:'. ! { �Y( r'.l 6 ;
t
VOLUME ESTIMATED COST $ FER $ `
(CUBIC/SQUARE FEET) i`
OWNER 1'('ijn , fril�lCl� r� � J� 1� �.✓�ti �j
ADDRESS BUILDING
BY
��, .� `•-
WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY' - PINK/F ASSESSORS COPY F'iRt P
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