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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 Application dote ��� 00 NOT WRITE BELOW THIS LINE V. PLAN REVIEW RECORD — For office use Plans Review Required Check Plan Review Dote 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 By Permit or Approval Check Date Number B Y Obto fined Obtained 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 Bui[ding ��/f� Use Group Permit issued 19 C 1 Building �� Fire Grading � Permit Fee l/sa Live Loading Certificate of Occupancy $ Occupancy Load A roved by: Drain Tile Plan Review Fee $ f TITLE CITY OF NORTHAMPTON �. MASSACHUSETTS OFFICE of the INSPECTOR of BUILDINGS !V 7 Page 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 DISTRICT LOCATION �K I• AT (LOCATION) LOCATION )RO•) � (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 ;0 M A. TYPE OF IMPROVEMENT D. PROPOSED USE – For"Wrecking" most recent use M –1 1 New building Residential Nonresidential 2 Addition(If residential, enter number 12 One family 18 Amusement, recreational of new housing uni ss a ded, if any, – in Part D, 13) � 'rJK/.'�� 13 Two or more family – Enter 19 � Church, other religious number of units– – – --)- 20 Industrial 3 Alteration (See 2 above) 14 Transient hotel, motel, 21 C� Parking garage 4 Repair, replacement or dormitory – Enter number 5 0 Wrecking (11 multifamily residential, of units ––––––– – --� 22 �� Service station, repair garage enter number of units in building in 15 C] Garage 23 [_ Hospital, institutional Part D, 13) 16 [7 Carport 24 L� Office, bank, professional � 6 Moving (relocation) 25 Public utility 17 Other – Speci/y — 7 Foundation only �/�o 26 School, library, other educational B. OWNERSHIP V 27 L] Stores, mercantile 28 Tanks, towers B D Private (individual, corporation, nonprofit institution, etc.) 29 Other – Specify 9 L_1 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 o4 improvement................ D school, secondary school, college, parochial school, parking garage for deportment store, rental office building, office building at industrial plant. To be installed but not included I If use of existing building is being changed, enter proposed use. in the above cost a. Electrical....................... b. Plumbing ....................... c. Heating, air conditioning.......... v d. Other (elevator, etc.)............. 11. TOTAL COST OF IMPROVEMENT $ �ol 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❑ 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. 4t. ........... 34 Other – Specify 42 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 Electricity 44 Yes 45K No 53. Number of bedrooms............. 38 Coal 39 Other – Specify NOM C Will there be an elevators 54. Number of Full.......... – bathrooms 46 � � Yes 47 No Partial........ t r � CA O "'= ear 3' '•�. tn' O m W e-* -�j o ►-3 0 P-9, A v b O lD Cr AD = h�l G G w y `C7 f!Q CD O ~ 0 G y R+ .0 Zn G• ._ � � O"� "s C• vets CL `b C �. IQ D fD o � O Cv G G. D O O G D G u Cd rA O O O O O O O G O G• G• cr Q I W N f+ ►� I I vc I I ara area o qQ Pr CA � l`J � � � y �, �, O C `�► A ¢� y d ►-� a °Q ° v, � a;s t 9