16A-020 IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address - Number, street, city, and State _ ZIP code Tel. No.
1.
NOTES and Data - (For department use)
Owner or fa.. ; ._ x
�r��. _ 01053 5 �
Lessee 1 cAte 1 At r �S 3
�' Builder's
' r
2. "�� tOVL."P.�. License No. a..,-.. < :. G�
. _�
. T' • . .if I �_! 4..,2)) �—
iiJl 1` .
Contractor ,
3.
___ -Cpl ..c& -e eJZ[ `te IS I L <A.51.,..(o I CIA i / au-el ? J - fl9G A....1..._
Architect or n/ /
Engineer ` a p ( 13e , (e A cta_AA 5 ✓lp ___ �C.l� /�
-
1 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.
Si of applica t Address 1 Application date
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Dote Plans B Date Plans By Notes
q Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Permit or Approval Check Obtained Number By Permit or Approval Check Obtained Number By
BOILER -
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 11
FOR DEPARTMENT USE ONLY
Permit number
Building f Use Group
Permit issued j fl 19 /( _
Building Fire Grading
Permit Fee $ ( Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $ ? , - .•�
f TITLE
L
`f CITY OF NORTHAMPTON
MASSACHUSETTS
VIII. ZONING PLAN EXAMINERS NOTES A �`�, .i
,1 r.:1 ; OFFICE of the INSPECTOR of BUILDINGS
DISTRICT ��. �� "
ff --
a�;y� Page �lt) Pl ot s APPLICATION FOR
USE ZONING PERMIT AND
INSPECTOR
BUILDING PERMIT
FRONT YARD
Z
IMPORTANT - Applicant to complete all items in sections: 1, 11, 111, IV, and IX. C)
SIDE YARD SIDE YARD / i
I. AT (LOCATION) 4 (t ka V S ' ems- D STR CT l!l
REAR YARD LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
NOTES
SUBDIVISION LOT BLOCK SIZE
V1
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 1 1 New building Residential Nonresidential
2 I 1 Addition (If residential, enter number 12 R1 One family 18 I I Amusement, recreational
of new housing units added, if any, 13 L i Two or more family - Enter 19 L J _ Church, other religious
13
D
Part D, )
IX. SITE OR PLOT PLAN — For Applicant Use i n number of units - - - 20 L J Industrial
3 LDt Alteration (See 2 above) _
:• •■2�, : 14 L I Transient hotel, motel, 21 C� P arking garage
i : :: _ :N•• =• : : :■ : : : :rppf• ■r '.:•■••sit 4 I I Repair, replacement or dormitory - Enter number
■ i
Hfa i /•a
■• • N r•r f H ip pN • N r •■ N ■ .
■. •■= r r ■•••r: r�li •• : =�f: hri:�i�• ::ifti •• ■ • o units - -. 22 S ervice station, repair garage
x:::•_• i• : � � • ■ • r • N■: :•rift : :: :Nr i � e ■ 5 Li Wrecking (I / multifamily residential, � f
` 60 0 N ■Ni • N■ t■N
■� •p iN • °fp our ai •p••r se N„ N e ■•s■ ■• • uf•�i: ••NNai• ■ enter number of units in building to 15 Garage 23 I J Hospital, institutional
r=■ 4a: ii r � r 4� -i- �: •� ■ ■ • : ::i:: : Part D, 13 24 %1 O ffice, bank, professional
i� e • • • ■ • .2.41:211:11:::::""a"" :. ::ri 16 7 Carport 2 5 P ublic unlit P
■ • i•::r• pf a = i• • _ : : :: 6 I I Moving (relocation)
• • • p i •• : •DiN�S • i :: ■ f ■• r 111:
� ■• �
17 ■N _1:N� L 1 Other - Specify Cl y
• 1• : • w: . ii: • : :f11f1•:s 1 411! 4 1 1 a :• • _ Foundation only
Np� : • r • •i :Ni :•:• ' •■ ■ : i 7 F
s I dti Y School, lib
26 coo, rar
• • • • ifl•i p .q ■• N Y.
: • y i� f :N •• ■•f • : :it : Nna• ■ i • � • •: : N•
other educations
: $ *l,r fi r : i : : 27 Stores, mercantile
■ ii i3:: i� :�■�T• : • N i �■rr: ■■a• B. OWNERSHIP i�
■ • • • • • sr! •• • f a • • 28 (-1 Tanks, towers
■ti� • • _ • i iiiiir.9:114/20:3 : � r :w :i•rr•• Nsi ■ � i•Na�i :N g 8 t4 Private (individual, corporation,
!= p • •N •• P
:r`:s •• w f • f• : • r • N• w i' i •■��p : nonprofit institution, etc.) 29 L1 Other - Specify
• NN! • •■i• M t N 1i.••i: • =rid• f� \•••11:11• :N■tff NiN
:E444 N•• ••: t::: ; 4111 i i:::■_111: ■ r: a ■� N b •■ ■ • • ■• a • = 9 � local government)
overnment)State, or
•N • f• •fi •• :■r •Nr g
H1 =: � • r iNif� ••N :•N � N� =•N ••a••NN■N :
` C- h : a ra : : ....1 C. COST (Omit cents) Nonresidential - Describe in detail proposed use of buildings, e.g., food
wN • • • •a pi aril a • uwprw H N
iiiiMil • . • • • •p • •p •N • .fN processing plant, machine shop, laundry building at hospital, elementary
�i li:l�i � :�i ■�i �i: � : =n : :■ :■N :N•■=••■N::• •::iii : LEA : S t} P 9 P P, Y 9 P
"� �- y N ■ s •N • • rift N Ni■• ■ :: : school, secondary school, college, parochial school, parking garage for,
"` : • • • •p� ■ • :■ 10. Cost of improvement $ � [�(jQ. Y 9 P P 9 g g
N• = . N ■ .a ... f pN 1 department store, rental office building, office building at industrial plant.
To be installed but not included If use of existin
• • • • • • f ar• ■N : • ■• N•N• NN N
• • • • N • fire• NNwu. • building is being changed, enter proposed � �: : : : :E " • : :i■ii::: N: :km= : _ :: 9 9 g osed use.
9 P P
p • N• ■ • • N far • in the above cost ��,,ee�� CO
pni =Nnr : r ♦: r =• : : • • N : ::ti :::: :•::: :: a. El ectrical Ono
•• ••• •• • gy• r • • :: �jir■ :••_ •• :: see::;::::::: = r2 1A ` ' * �{-/�� ' J�`p SO
SR r : i • :g� � :::: ::5g •• :: :uN N• : ■■ b. Plumbing
: :: a. r . SS 2'i 4 rrr• : : _ _ muse
't • • • •
__ Ni : , f a i : =:: iii:: : :11 5 = :: : : :: :■ ■p : : ■;
:: : : : ::::: : _ = c. Heating, air conditioning
•r•" N• :: • fN
• •p � Ni. • : : :: : ■ d. Other (elevator, etc.) ,
:•••r•:••••: •N•: : : ._ /
.
: • : :: : : : : : : : : ::ggli :: : : 11. TOTAL COST OF IMPROVEMENT $ 1 7 ( O •
• ::::::::1:41:::011; N ' :: : : ::: ::: : : : : : : ::•eme �` III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L;
6 441:144114:3.....r4=181111 i E :: JI . ; mum: for wrecking, complete only Part J, for all others skip to IV.
:N
::: N•Nm :.•.: : :: ••■ • •.• �: : :::: : ••:: :r• ■: : ' E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
• p
48. Number of stories
6 • oN _ :n : : :: • • _ •� 3 ■ 30 L Masonry (wall bearing) 40 L] Public or private company
�-1 49. Total square feet of floor area,
r:: :: nsam Nn.: : ::■•• lm: : 31 LJ Wood frame 41 L j Private (septic tank, etc.)
••a ••• •a• �� •_ : :•• all floors, based on exterior
•::
: : : : :: : ::::a� : :I_ : : :u:::::: : :: : :I: • 32 1 Structural s dimensions 56
•'r 1 : : „ : :: :::: ::ii •. = •• i :• ::u : :: ::: :mum. 33 L Reinforced concrete H. TYPE OF WATER SUPPLY 50. Total land area, sq. ft.
■i: :.N : :: :i'�S::II :: $�::• m.: 111•■ : : : :• :: tem:: : ::a 34 [_I Other - Specify 42 L_L Public or private company —
11::::::::::::11::::111: • ■r•r • ' I K. NUMBER OF OFF- STREET
4=r =6::::: : :' : : :::5 =: :: °., 43 Private (well, cistern)
#� ::: : : :.i li : tt=t a 1 i :•+ PARKING SPACES
:::a. lino. • ■
LIFfiiii$ i:: : : :rr =li =g lifflll : :::rN••r: : : :: 51. Enclosed
l3:: :::22::32 ItIrarnar.2313rag20:1113Mannar F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
: : :: • • ; N r : :N:@j:::::::: : : : : :N r
r ■i ■ n:
w mum fur : ff iisi ii ! •r ■Og : 35 l I Gas Will there be central air 52. Outdoors
p 36 Oil conditioning.
111111/11111111111211111111911111111111111111:111111:1:1 _gen L i L. RESIDENTIAL BUILDINGS ONLY
+ :14:4;l LL ■• • ■r■• 37 Electricity 44 Yes 45 mil No
LL ” i . ..:::i: :: : :i :M 4:111: ■ i:: :N ■p■ El y L _ 53. Number of bedrooms
. + T . 1 I EM n �i •�g� iiiiiia a ti I i s :•: : 38 I Coal
+tr ' ��_r_ : inVIUM BIRMIR::••::•i■ifN : : : : : :r•.r• :' 39 L Other - Specify _ Will there be an elevator" Full
54. Number of
46 T1 Yes 47 Li No bathrooms
Partial