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17A-142 (10) VIII. ZONING PLAN EXAMINERS NOTES DISTRICT USE � � �(� �i..(i�i FRONT YARD s C SIDE YARD �t'rj ���' SIDE YARDc REAR YARD NOTES IX. 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IV. IDENTIFICATION — To be completed by all applicants Name Mailing address — Number, street, city, and State ZIP code Tel. No. 1. ' L? i 2'-Z C.& —y— // —6 Owner or � 4^U Lessee C rr Builder's 2. Zt L lLt L' ''Q G° 1 S'T 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. $ignat re of applicant Address Application date j 00 NOT WRITE BELOW THIS LINE V. PLAN REVIEW RECORD — For office use Plans Review Required Check Plan Review Date Plans By Date Plans By Notes 9 Fee Started Approved BUILDING PLUMBING MECHANICAL ELECTRICAL OTHER is VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS rova I Check Date Number Permit o Date Permit or A umer pp N b B Obtained y P it r Approval Chec Number 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 I I OTHER VII. VALIDATION Building �0 FOR DEPARTMENT USE ONLY Permit number Building -7 q Use Group Permit issued - 19_ Building V Fire Grading Permit Fee �� �� Live Loading Certificate of Occupancy Occupancy Load Ap y: r Drain Tile .�.�.� t' Plan Review Fee $ 1 TITLE NOTES and Data — (For department use) z� ' 0 `!It CITY OF NORTHAMPTON OFFICE OF THE INSPECTOR OF BUILDINGS 212 MAIN STREET � 2 APPLICATION FOR 17ANORTHAMPTON, MA. 01060 ` PLAN EXAMINATION AND BUILDING PERMIT z IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. G IS f D I S T R I ZONIN �—� � ❑� �,�/� I• AT (LOCATION) LOCATION / (N 0.) (STREET) OF BETWEEN T^'T /6 1 AND BUILDING (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE N 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 -4 1 ❑ New building Residential Nonresidential 2 ❑ Addition(If residential, enter number 12 One family 18 ❑ Amusement, recreational of new bousing 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 l l Transient hotel, mote , ❑ 21 ❑ Parking garage 4 Repair, replacement or dormitory — Enter number 22 Service station, repair garage 5 ❑ Wrecking (If multifamily residential, of units ------- - -- ❑ enter number of units in building in 15❑ Garage 23 ❑ Hospital, institutional Part D, 13) 16 ❑ Carport 24❑ Office, bank, professional 6 Moving (relocation) p ❑ ❑ 25 ❑ Public utility 17 Other - Specify 7 ❑ Foundation only 26 ❑ School, library, other educational B. OWNERSHIP 27❑ Stores, mercantile 8 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 ref ,) processing plant, machine shop, laundry building at hospital, elementary 10. Cost of improvement................ l + ` 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 ..................... G't'( c. Heating, air conditioni}ngg.��.�.�,....... d. Other (elevator, etc.).l`° I'Y.r.. 11. TOTAL COST OF IMPROVEMENT $ G L 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 I �'y`� 48. Number of stories................ 30 Masonry (wall bearing) 40 I-�Public or private company 49. Total square feet of floor area, 37 Wood frame 41 E] Private (septic tank, etc.) all floors, based on exterior 32❑ Structural steel dimensions ..................... G'Z/' 33❑ Reinforced concrete H. TYPE OF WATER SUPPLY 42 Public or private company 50. Total land area, sq. ft. ........... 34❑ Other - Specify ❑ p 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 Na 53. Number of bedrooms.....�.... 38 ❑ Coal 39❑ Other - Specify Will there be an elevator? Full...�..... 54. Number of 46 ❑ Yes 47[RN. bathrooms Partial....... To' k+x3 j ELEC � t , } ♦ '•. �� �� 77 fi IME Jp 2 U. All IRe ' ' CERTiFMATS lSSt,I;1�� DATE BU k, s TIFICAT 'f DATE ! 19M, _ ;___ P£I�2N(iT ND 'lift d?�PLi4NT a �s r S< . a ` 04 63 _ RiAEt3 f'Cilfi,1'Bt'$ LiE£HSB) BUT T ( t-) 'ST* t:� a taw L)14Gdr6i TS,", 4F,IMP '> Ra,. . it*OPOSE1r,OSE) _ . .i� ... TCOA {ON) ` )QTR C (NO.) (STRIS;ET) P e #SETWEN' AND + ry s LOT 1% SUaDwis1QN S ! 3 (y0 `_ BlOC1 a PT. iNip $Y fT..'Y, G B` T IN ke-f4"T Affil0�hGla fFC 13M i CO4iWOICT t)N x a't - TYPE 4 t USE ?iOUP "#MENT;WALL$ OR F JQNDA-r ION (TAP 0. � 'REhAARKS: } _ t yyg AREA'OR YOt ll1#E r " (tu's?cratzuA��FE>iT) � arrtxyfrrttrtwtim. w . , OWNER ' F8 E - IR?iCA3'E ADDRESS