17A-288 (10) Vill. ZONING PLAN EXAMINERS NOTES
DISTRICT
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
IX. SITE OR PLOT PLAN For Applicant Use
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants ,
Name Mail ing'address — Number, -street, city, and .State ZIP code Tel. No.
O /
Owner or � � t /u(11 6) �� •'Z'S
Lessee
!C'�iG 4`✓ Builder's
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.
Signotu a of applicant Address Application date
,� h12 _ A2 ::T__27 S1 1
' D NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RE 0 — For office use
Plans Review Required Check Plan Review Date Plans By Date Plans By Notes
Fee Started Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL Is
OTHER Is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number B Permit or Approval Ch Date Number B
Obtained y pP rova Check Obtained By
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
II. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building ����` _ , �� 19 Use Group
Permit issued sued e�e���
Building Fire Grading
Permit Fee $ Live Loading
Certificate of Occupancy $ Occupancy Load
M:�Drain Tile $
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
9� it
MASSACHUSETTS
$ e OFFICE of the INSPECTOR of BUILDINGS
„„ Page !74\ Plot '� APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
ZONING
I• AT (LOCATION)
LOCATION (NO.) (STREET) �/ y
OF BETWEEN �X ,� J2f� /C �J !'°'+"t AND //���C�� E
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
m
-4
1 ❑ New building Residential Nonresidential
2 Addition(1 residential, enter number
J 12❑ One Family 18 ❑ Amusement, recreational
of new bousing units added, if any,
in Part D, 13) 13 v Two or more family - Enter 19 ❑ Church, other religious
number of units- - - - ••-_`J 20❑ Industrial
3 ❑ Alteration (See 2 above)
14 ❑ Transient hotel, motel, 21 ❑ parking garage
4 Repair, replacement or dormitory - Enter number
5 ❑ Wrecking (If multifamily residential, of units ------- - -! 22 Service station, repair garage
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13) ❑
16 Carport 24 ❑ Office, bank, professional
6 ❑ Moving (relocation)
17❑ Other - Specify 25 ❑ Public utility
7 ❑ Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8 Etq-lrivate (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
, 's school, secondar y school, college, p arochial school, p arkin g garage for,10. Cost of improvement,,,,,,,,,•••••••
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..................... C}) ) x
r
b. Plumbing .....................
)l-y9&
c. Heating, air conditioning.........
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT se;2docr ,
III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L;
for wrecking, comp ete only Part J, for all others skip to IV.
PRINCIPAL TYPE OF FRAME 'G,. TYPE OF SEWAGE DISPOSAL DIMENSIONS Z-
❑ Masonry (wall bearing) 40 Public or private company Number of stories................
s 49. oral square feet of floor area,
31 Wood frame 41 '❑ Private (septic tank, et .)
a loors, based on exterior
32 tructuralsteel dime ions ..................... J�(
33 ❑ Re' forced concrete H. TYPE``QF WATER SUP LY
\ 50. Total land ea, sq. ft. ... � 3 (�C'�
34 Other - Specify 42 �PuD(`c or privat company
43 ❑ Private (well cistern) K. NUMBER OF OF TREET
PARKING SPACES
V30ther E F HEATING FUEL/[_ H\ANICAL 51. Enclosed ......... .. ..........
central bir 52. Outdoors..... ............ .....
L. RESIDENTI BUILDINGS ONO',
45 i," ( No 53. Numb of bedrooms.............
cify an elevator? \ Full..........
5 Number of
47�No \ bathrooms
Partial.......
DEPT. OF BUILDING INSPECTIONS BUILDING z° 0 0
212 Main Street 0<
NN"orthampton, MA 01060 PERMIT <a
17A-'�� '�" VALIDATION
ATE 19 PERM T IVOe�
APPLICANT (v�+ ADDRESS A 9
(NO.) (STREET (CONTR'S LICENSE)
NUMBER OF
PERMIT TO 1 STORY DWELLING UNITS
TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) - DISTRICT_
(N0.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE E GROUP BASEME T WALLS OR FOUNDATION
(TYPE)
REMARKS:
AREA OR
VOLUME ESTIMATED COST $ FEEMI $ cl0
(CU DARE FEET)
OWNER r
BUI
ADDRESS BY
WHITE — FILE COPY . GREEN — FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSE ORS COPY pINT' IIP