35-120 (6) ZONING •
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
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Applicant ......•
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be cbmpleted by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
r
Owner or S S "✓ �
Lessee 11/`U � Q��fp' 21
TTIICC.. �% Builder's C7 A
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 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........
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