34-018 (5) Vill. ZONING PLAN EXAMINERS NOTES
DISTRICT
SIDE YARD SIDE YARD
REAR YARD
IX. SITE OR PLOT PLAN For Applicant Use
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NOTES and Data — (For department use)
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IV. IDENTIFICATION — To be completed by all applicants
�lName D� Mailing address — Number, street, city, and Slate ZIP code Tel. No.
Owner or 610
1. �(Ct L C en 2 a— �p
n
Lessee lJ
OCO�O
Builder's
C 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.
Signature of applicant Address ,
n I Application date
i
DO 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 8 Permit or Approval Ch Date Number B
Obtained Y Pp Check 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 S'`�' `�` 19
Building Fire Grading
Permit Fee $ � '��
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $ / � �.
ITLE
CITY OF NORTHAMPTON
�. .� MASSACHUSETTS
r r
$ OFFICE of th INSPECTOR of BUILDINGS
Page Plot APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: I, 11, 111, IV, and IX. C)
ZING
I• AT (LOCATION)
g �V 4 y _H1 C� 6,•-Y M DIOSTR CT .
LOCATION (NO.) (STREET)
"'OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
,II. TYPE AND COST OF BUILDING — A11 applicants complete Parts A — D X
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— — — — 20❑ Industrial
3 ❑ Alteration (See 2 above) 14 Transient hotel, morel,
❑ 21 Parking garage
4 Repair, replacement or dormitory — Enter number
5 Wrecking (!f multifamily residential, of units ——————— — -� 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) 25❑ Public utility
17❑ Other — Speci/y
7 ❑ Foundation only 26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8 M 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,,,•,•.••....... / /. C'O 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
a. Electrical.....................
b. Plumbing ..................... ` A
0
c. Heating, air conditioning..........
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT $ v }
III. SELECTED CHARACTERISTICS OF BIUVLDING — 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❑ Masonry (wall bearing) 40 ❑ Public or private company
31�Wood frame 41 ❑ Private (septic tank, etc.) 49• Total square feet of floor area,
all floors, based on exterior
32 Structural steel dimensions .....................
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY
50. Total land area, sq. ft. ...........
34 [__1 Other — SpeciJy 42 Public or private company b
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 ❑ Electricity 44 ❑ Yes 45 r-1 No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other— Specify Will there be an elevator? 54. Number of Full..........
46 ❑ Yes 47 ❑ No bathrooms partial.,......
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