25C-106 (9) ZONING PERMIT PS-C -
APPLICATION
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[.�lrk the appropri,--te box to indicrte t. c 1111C Of t1ir P Ircrl:
1"on-Coiifor!,Anr- 1,ot :,z-:d;or Structure.
Residcnti-il = sinGle- F,-lily
FTI Durlex QOthe3
Business
Industrial
Institutin-1
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-rd Approvel (SI)CCi 1 perrlit V,--ri.ince)
= Cit.1 Council (x"P?ci-d Exception S. 10. 10)
.1atershed Protection District Ovci.-1,1.,�: (Z.�'.. SECA. Y
'irking Space Requirement:,-: rc
4j Cct. ' .I) Poqui� !—Prj.p0se '
cading Space Pcquiremrntc: Rcquiz-(A—PropoceJ
;ip'ns: (Z.O. Art. VII) Y'd c 0 1.0
'n Y C 13
Performance Stapdai-(J�3: -L,7.0. Art. XJI) F Or
-,lot plan Q YCE-, Q No uitr Flan Q Yes Q :"c
S. 10.2) 0 27 n n d 1 11
This scctioj,. for er,-j(,jrj,
=Approval js
P e t ur n: (i'oj- in rot pi t,i -n
Sir. �ture of qr, 1 j- t 4 D�"t
For ALL buildings within Fire District and for other buildings costing $10,000.00 or more, plans
and specifications must be submitted to the Inspector of Buildings for examination and approval.
If building is to be moved give details relative location as for a new building.
Application for to Build?/ '
` 19..
Northampton, Mass., ...... :..............»........ .„».....:..
To the Inspector of Buildings:—
The undersigned hereby applies for a permit to build, move, alter, or repair, according to the
following specifications.-
1. Owner's name .......». .......»................»....„...............................,„»..»..........................,.....................................................................................
2. Owner's address .„.,;:. ..w.: ............»„.„..„. .»....„.........»... :».1..»»..»...............................„............................»....»........................„........
3. Architect's name ..................................................»..........................»..................................................................................................................
4. Builder's name ......... ;.x:.,................; ............................».........................„..........................................................
5. Builder's address ....................... ..........„.,,.......... .....„.........................................................................„....„.„........
6. Location of Building. Street No. ....... ........ ........» „.... ,.....».;.................;...............................................................„..
7. Is this a removal or new building .......................................»...................„.......„.......................................................... .....................
8. If removal, from where .....................................................................,.................. ._.................................................................................
9. What is the purpose of building ...... ..;»»..:. .°.„...w............ ... ...................................................................................................
10. Material of building .........................._..: ........ .................. .........„...........................................».........................................
11. If a dwelling, for how many families...................?...................„.....Number of rooms ............... .. ..........................
12. Is there to be a store in the building a
13. Size of building, No. of feet front :. ;No of feet deep � ; No. of stories ........:..»........
14. Size of ell, No. of feet front ........................: No. of feet deep .......................; No. of feet high ..........................
15. Size of Lot .............. /. ... ...».......................Feet Wide ......... �.................. Feet Deep ....2 �'..............
16. How near the-line of street ......................................................................................................................„.........................„.......................
17. How near the line adjoining lot. Right ............................„.....; Left...........„.......................; Rear.................................
18. Nearest building is .....„..........................feet in a...................................................... direction ........................................ ..........
19. Material of the floor ...................................»..........„.................»................„........................._.........................»...........................»....„...........
20. Size of timbers, 1st ...........„....».....; 2nd ........................ : 3rd ........................; 4th .................„...........; 5th .................„...........
21. No. of feet span.»........„.............».............„.............„.............. ; Distance on centers ...............................................„.......................
22. Will the building be erected on solid or filled land .............................„................................................................................
23. What is the material of foundation .....»....„...».....:..::.........................„....»...................».............; Footing ......„...:..„.........
24. Will the roof be flat or pitched ...........».„....»............................»....„.....; Covering....................»....»...................„....................
25. Heat; steam, hot water, furnace, stoves .................„.......................; Power oil burner .............................„.................
26. Fireplace .....»........................................„.„....................; Insulation ..............»...............................................................................................
27. How many sinks ............: Toilets .....».....; Lavato ries ..„.....; Bathtubs.........; Showers............; Settubs .........
28. City Service; Water ........................ Sewer ........................; Road Surface ..........................; Sidewalk ........................
29. Is lot on accepted street ..............„.......„..........„.....................„...................»..........„.....................................».............„...............................
30. Estimated cost (must be filled out) ........./.,..i ..................„.......»..............................................»...............................„..............
Applicant agrees to give the Inspector of Buildings 24 hours' notice before lathing or
plastering this building. This building will conform to the requirements of the law.
Signature of
applicant . „ ......... .................»....».... .. ».. ...................................................................................
✓,.�_;, . No..............................».
......
REMARKS
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