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ar. t �
(NO.) (STREET)
AND
(CROSS STREL
(CROSS STREET)
LOT
)N LOT BLOCK SIZE
N
i OF BUILDING — All applicants complete Parts A — D
M
/EMENT D. PROPOSED USE — For-Wrecking" most recent use M
Residential Nonresidential
residential, enter number 12❑ One family 18 Amusement, recreational
using units added, if any, 13 Two or more family — Enter `; 19 n Church, other religious
13} number of units— — — — --,)-fi 20 Industrial
(See 2 above) 14 Transient hotel, motel,
21 [—] Parking garage
eplacement or dormitory — Enter number
g (if multifamily residential,
of units ——————— — -� 22 �� Service station, repair garage
lumber of units in building in 15 Garage 23 �� Hospital, institutional
7, 13) 16 Carport 24 Office, bank, professional
(relocation) p
9 ( 17 E7 25 Public utility� Other — Specify
dation only 26 School, library, other educational
41P 27 �] Stores, mercantile
28 Tanks, towers
vote (individual, corporation,
nprofit institution, etc.) 29 Other — Specify
ublic (Federal, State, or
)cal government)
(Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food
processing plant, machine shop, laundry building at hospital, elementary
(}C) , school, secondary school, college, parochial school, parking garage for,
Cost of improvement................ deportment 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.
a,o. the above cost
Electrical.....................
b. Plumbing ..................... \�
c. Heating, air conditioning.......... \
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT $ _ \\
SELECTED CHARACTERISTICS OF BUILDING — for w k ngdcomple e only additions,
Part J,forl all others skip to IV.
PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS \
48. Number of stories...............
30 LD Masonry (wall bearing) 40 � Public or private company \
49. Total square feet of floor area,
31 Wood frame 41 F� Private (septic tank, etc.) all floors, based on exterior
dimensions ....................
32 Structural steel \
33�� Reinforced concrete H. TYPE OF WATER SUPPLY
50. Total land ores, sq. ft. ...........
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 1. TYPE OF MECHANICAL \
35 [1 Gas Will there be control air
52. Outdoors........................
conditioning? L. RESIDENTIAL BUILDINGS ONLY
36 L Oil _
44 Yes 45 ~: No 53. Number of bedrooms..............
37 �j Electricity �—�
38 n Coal
Will there be an elevator" Full..........
39 Other — Specify 54. Number of
bathrooms
46 � Yes 47 '� No Partial........
.�
.�
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.� 1 .
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..:
,�
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s R
tS A
Date F U File No.
PERMIT APPLICATION
DEC 13 i rdinanoe sect/ion 10 . 2
1 , a icant:
Telephone:
01060 S�5-sib'7 CC7
U1p6p ,
2 . Owner of Property. iy
Address : Telephone: 57f,�y.- (� /
3 . Status of Applicant: Owner �\Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification : Zoning Map Sheet# _
Zoning District (s) -'
Street Address T?,
5 , Compliance with Zoning: Existing Proposed .
Use of Structure/Property
Size of Structure (sq. ft , )
Building height
Building coverage
Setbacks - front
- side
- rear '
Lot Size
Frontage
Floor Area Ratio
% Open Space
Parking Spaces
Loading Spaces
Signs
Fill (volume & location)
6 . Narrative Description of Proposed Work/Protect: (Use
additional sheets if necessary) ,c11Z,6?v'=te f vv� 7`fi 4-LeLaucYA-,-
7 . Attached Plans : Sketch Plan Site Plan
8 . Certification: I hereby certify that the information, contained
herein is true and accurate to the best of my knowledge.
Date: -- Applicant ' s Signature:
THIS—SECTION^FOR OFFICIAL USE ONLY: r
i
.___k�
' Approved as presented
' Approved
as presented
Reason for Denial:
Signature o£ Building inspecto ____ Date /1 ��
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NOTES and Data — (For department use)
B.
Vill. ZONING PLAN EXAMINERS NOTES
DISTRICT
SIDE YARD SIDE YARD
REAR YARD
NOTES
IX. SITE OR PLOT PLAN For Applicant
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CITY OF NORTHAMPTON
g• MASSACHUSETTS
$ e OFFICE of the INSPECTOR of BUILDINGS
.�T Page � • Plot APPLICATION FOR
INSPECTOR ZONING PERMIT ANI
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, III, IV, and 1X. O
I. _1� 'ort l . ,,7,° 1 e OL'enr, ? ZONING
AT (LOCATION) DISTRICT,
LOCATION ("� ) STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
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
M
10 New building Residential Nonresidential
2 O Addition(If residential, enter number 12 [:] One family 18 Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 J Two or more family — Enter 19 Church, other religious
number of units— — — — 20 n Industrial
30 Alteration (See 2 above)
14 Transient hotel, motel, 21 Parkin e
4 Repair, replacement or dormitory — Enter number g garage
5 ❑ Wrecking (11 multifamily residential, of units ——————— — —� 22 Service station, repair garage
enter number of units in building in 15 p
23 Ho
Garage Hospital, institutional
Part D, 13) g
16 Carport 24 F—] Office, bank, professional
6 Moving (relocation)
17 C� Other — Specify 25 -� Public utility
� 7 � Foundation only
26 n School, library, other educational
OWNERSHIP 27 Stores, mercantile
o F—] 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
processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement,••,,,,•,_,,,•„ '� � .�-".% school, secondary school, college, parochial school, arkin
p g garage for,
department store, rental office building, office building at industrial plant.
"ro be installed but not included If use of existing building is being changed, enter proposed use.
in the above cost
a. Electrical.......................
b. Plumbing ....................
c. Heating, air conditioning.........
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT $
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
30❑ Masonry (wall bearing) 8. Number of stories................
9) 40 � Public or private company
31 Wood frame 41 Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior
32 Structural steel dimensions .....................
33 Reinforced concrete H. TYPE OF WATER SUPPLY
34 Other — Specify 42 Public or private company 50. Total land area, sq. ft. ...........
43 �� Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed .......................
35 Gas Will there be central air 52. Outdoors........................
36 Oil conditioning?
37 Electricity L. RESIDENTIAL BUILDINGS ONLY
Y 44 n Yes 45 No
38 Coal
53. Number of bedrooms..............
�
39 Other — Specify Will there be an elevators Full..........
54. Number of
46F I Yes 47 D No bathrooms
Partial.......
1
�^
IV. IDENTIFICATION — To be completed by a// applicants
Name Mailing address Number, street, cy-Y, and State ZIP code Tel. No.
Owner or
Lessee
License No.
Contractor
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.
Sign�g f applicant Address 3 Application date
elm
V. PLAN REVIEW RECORD For office use
Plan Review Date Plans By Date Plans By Notes
Plans Review Required Check 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 o Date d Number By
Obtained btaine
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 Use Group
Permit issued 9 Fire Grading
Building
Permit Fee $ 7 Live Loading
Certificate of Occupancy $ Approve poncy oo
Drain Tile $
Plan Review Fee $
TITLE
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