17C-309 (4) Vill. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE A
C2
FRONT YARD
/ J
SIDE YARD
SIDE YARD
REAR YARD
NOTES
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NOTES and Data — (For department use)
G d
IV. IDENTIFICATION To be completed by all applicants
Name Mailing address Number, street, city, and State ZIP code Tel. No.
-'A J\ J
Owner or
Lessee
Builder's
2. C' t f 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 appl i cqi
!pn as his authorized agent and we agree to conform to all applicable laws of this jurisdiction.
Signatur e of/applican J
Address
Application 4ate
A/
00 NOT W R I T E BELOW T H I S L I N E
V. PLAN REVIEW RECORD For office use
Plan Review Dote Plans Dote Plans
Plans Review Required Check Fee Started By Approved By Notes
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER 1$
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date
Permit or Approval Check Obtained Number By Permit or Approval Check Obtained Number 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
VII. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Bui[ding
Permit issued (144t-f j 19 S3 Use Group
Building Fire Grading
Permit Fee $ 1&0 Live Loading
Certificate of Occupancy $ Occupancy Load
Ap ed by: ?
Drain Tile $
Plan Review Fee $
TITLE
} - CIII�Y OF NORTHAMPTON
MASSACHUSETTS
OFFICE of the INSPECTOR of BUILDINGS
$ Page /7C Plot O? APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: I, 11, 111, IV, and IX. /// O
///eIr -f 7— ZONING .DISTRIC
AT (LOCATION)
LOCATION (NO.) (STREET)
OF BETWEEN Jl Wpb f- OAI) AND S✓fE�`'GiELJ N�`
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
1 New building Reside tial Nonresidential
2 ❑ Addition(If residential, enter number 12 ROne family 18 ❑ Amusement, recreational
of neu) housing 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
h
Transient hotel, mote ,
❑ 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (If multifamily residential, of units ——————— — -- 22 D 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 — SpeciJy 25 ❑ Public utility
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
processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement,,,,,,,,,,,,,,,,
f' � 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 .....................
c. Heating, air conditioning..........
d. Other (elevator, etc.).............
r� n
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. TYP7F SEWAGE DISPOSAL J. DIMENSIONS
30❑ sonry (wall bearing) 40 Public or private company Number of stories..............
31 Wood frame 41 ❑ Private (septic tank, etc.) 49. Total square feet floor area,
all floors, based on exterior
32 ❑ Structural steel dimensions .....................
33 ❑_� Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — Specify 42 gPu6lic or private company 50. Total land area, sq. ft. ...........
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........................
conditioning?
36 ❑ it �/ L. RESIDENTIAL BUILDINGS ONLY 3
37 Electricity 44 ❑ Yes 45 E No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — Specify Will there be an elevator? Full..........
54. Number of
46 [-] Yes 47 No bathrooms /
Partial........
0
21, l4ail,n t
BUILDING
Z.
V) 06
PERMIT
17r 77
VALIDATION
DATE 19 PERMIT NO.
APPLICANT ADDRESS
(NO.) (STREET) (CONTR'S LICENSEI,
PERMIT TO l STORY NUMBER OF
*' DWELLING UNITS
(TYPE OF IMAMLMNT) NO. (PR8P.h. USE)
AT (LOCATION) — fl-,' 11 c-rr,7 i T��-i-vc ZONING IJT�B
(No.) (STREET) -DISTRICT
BETWEEN Rr 7 y, P c,p ILL AND ��hcfl.icld LaVL
(CROSS STREET) (CROSS STREET)
SUBDIVISION LOT—BLOCK LOT
- SIZE
BUILDING IS TO BE—FT. WIDE BY—FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP —BASEMENT WALLS OR FOUNDATION
(TYPE)
• ulans rc7-
REMARKS: r c r-,...t to bul1 t� rc-, one f<'_Lj
AREA OR 1142 sevirc, OR, e)r)
VOLUME PERMIT $
(CUBIC/SQUARE FEET) ESTIMATED COST $ FEE
OWNER An tl,,ony & "Xp
6r6 73r:.,-,,-c P.o?r
ADDRESS ' BU DI
BY4
T 7—
WHITE FILE COPY - GREEN - FIELD COPY CANARY - APPLICANT COPY PINK -//ASSESSORS COPY