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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Nurnbcr, stmt, city, and State ZIP code Tel. No.
Owner or 2,
Lessee &0 �+✓3-
Bui Ider's
2. License No.
Contractor
3.
Architect or
Engineer S eo FA .S
I hereby certify that the proposed w64 is authorized by the owner of record and that I have been authorized by the owner to
make this applicatio as his authorized agent and we agree to conform to all applicable laws of this jurisdiction.
ig ature of p licant Address Application date
b -� � Zy
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date P y Ions B Date Plans By Notes
Fee Started Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approva I Check Date Number B Permit or Approval I Check Date Number B
Obtained y Pp 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 19 P2,
Building Fire Grading
Permit Fee $ 2�� U+
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $ r`
T L E
CITY OF NORTHAMPTON
9� "$ MASSACHUSETTS
y OFFICE of the INSPECTOR of BUILDINGS
Page Plot �,� APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT — Applicant to c C)
complete all items in sections: I, 11, Ill, IV, and IX. K'��^✓7�
GO l I I I `S I ZONING
AT (LOCATION)
I. b O tl DISTRIC Y�
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D A
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
m
1 ❑ New building Residential Nonresidential
2 Addition(► residential, enter number
f 12 F-1 One family 18 ❑ Amusement, recreational
of new bousing units added, if any,
in Part D, 13) 13 Two or more family — Erzter � 19 ❑ Church, other religious
number of units— — — — 20 ❑ Industrial
3�.Qlteration (See 2 above)
14 E] Transient hotel, motel, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (if multifamily residential, of units ——————— — -i 22 Service station, repair garage
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13)
16 ❑ Carport 24 ❑ Office, bank, professional
6 ❑ Moving (relocation)
17 Other — SpeciJy ,0 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
r processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement,,,,,,,,,,,,,,,, J�DO, 00 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 e�
a. Electrical..................... .p
b. Plumbing ..................... C
c. Heating, air conditioning..........
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT $,S0 00.C)
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
30ttA Masonry (wall bearing) 40 Public or private company 48. Number of stories..............
31 ❑ Wood frame 41✓❑ Private (septic tank, etc.) 49• Total square feet of floor area, �y
all floors, based on exterior (�
32 ❑ Structural steel dimensions ..................... Q
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — Specify 42 F-1 Public or private company 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 TYPE OF MECHANICAL
35 Gas there be central air 52. Outdoors........................
36 ❑ Oil condi ' ning? L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 ❑ Yes 45 No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — Specify Will t re be an elevo ? Full..........
54. Number of
46 ❑ Yes 47 bathrooms Partial........
f
BUILDING zQ
PERMIT a
� VALIDATION
(nom I3 ATE 2 19� PERMIT NO. �7�
APPLICANTa/`�3"- " 17 ADDRESS Po acy 6 7r
(NO.) (STREET) (CONTR'S LICENSE)
�_ d -� ///�'//���y�� -- jj..��''��rr ,,,� �f NUMBER OF
PERMIT TO [ 7 ► (l' ) STORY 1`2h "''- _ onl '� DWELLING UNITS _
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
,7 ZONING
AT (LOCATION) 0 DISTRICT
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (GROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
17 � . R� � '1 (TYPE)
REMARKS: �`••��YL `e 1 y , f
AREA gCl�J ESTIMATED COST $ FEE MIT
VOLUME $-
r
(CUBIC/SQUARE FEET)
/2
OWNER BUIL NG PT.
p 5 -w.
ADDRESS 20 +`'w/ BY
WHITE - FILE COPY GREEN - FIELD COPY CANARY ^ APPLICANT OPY INK SSORS COPY