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VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
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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.
1. F f •�
Owner or
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.
Signature of p Address Application date
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plan Review Date Plans Date Plans
Plans Review Required Check Fee Started BY Approved BY Notes
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 Obtained Obtained N b 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 �?
Building
Permit issued l U.� E"� 19 Use Group
Building fy1 /2 Fire Grading
Permit Fee
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $ <------17
Plan Review Fee $
TITLE
o - CITY OF NORTHAMPTON
B. MASSACHUSETTS
$ e OFFICE of the INSPECTOR of 'BUUILDINGS
Rage �`� Plot APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
ZONING
I• AT (LOCATION) DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN AND-
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V1
II. 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 120 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 J Industrial
3 Iteration (See 2 above) 14 Transient hotel, motel,
❑ 21 �_. � Parking garage
4 L Repair, replacement or dormitory - Enter number
5 ❑ Wrecking (If multifamily residential, of units ------- - -� 22 � � Service station, repair garage
enter number of units in building in 15 Garage 23 Hospital, institutional
Part D, 13) 24
16 � Carport Office, bank, professional
-�
6 Moving (relocation) Public utility 25
17�] Other - Specify ��
7 n Foundation only 26 School, library, other educational
B. OWN RSHIP 27 L Stores, mercantile
8 Private (individual, corporation, 28 n Tanks, towers
nonprofit institution, etc.) 29 L--] Other - Specify
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,,,•••.......... $ 016b,10 school, secondary school, college, parochial school, parking garage for
department store, rental office building, office building at industrial plant.
Fo be installed but not included If use of existing building is being changed, enter proposed use.
in the above cost
a. Electrical.......... ........... r
b. Plumbing ..................... _ `7
c. Heating, air conditioning.........
d. Other (elevator, etc.)............. _
11. TOTAL COST OF IMPROVEMENT 1i 6CO. 00
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 C� asonry (wall bearing) 4J �� Public or private company
41 r Private (septic tank, etc.) 49• Total square feet of floor area,
31 Wood frame I_ p all floors, based on exterior
32 n Structural steel dimensions .....................
33E] Reinforced concrete H. TYPE OF WATER SUPPLY
Other 42 �� Public or private company 50. Total land area, sq. ft. ..........
34
- Speci/y
43 Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 E Gas Will there be central air 52. Outdoors........................
36E_1 Oil
conditioning?
�__ . _ L. RESIDENTIAL BUILDINGS ONLY
37 L_ Electricity 44 Yes 45 /No 53. Number of bedrooms.............
38 Coal -
39 Other - Specify Will there be an elevator° Full..........
- 54. fJumber of
-� bathrooms
461- Yes 47 No Partial........
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