29-352 (8) ZONING NOTES DISTRICT 12,A MENOMONEE
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FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
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NOTES and Data — (For department use)
s�
IV. IDENTIFICATION — To be completed by all applicants * . n
Name Mailing address — ;\'urnbcr, strut, city, and State ZIP code Tel. No.
ate`�
Owner or
Lessee
Builder's
2. License No. ^
Contractor
CtAl
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 aut rized age and we agree to conform to all applicable laws of this jurisdiction.
/17 11 Signat re of applicant ^ / Address Application date
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
Fee Started Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date
Permit or Approval Check Obta ned 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
II. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number IT
Building Use Group
Permit issued ( 19
Building Fire Grading
Permit Fee $ '�
Live Loading
Certificate of Occupancy $ Occupancy Load
A ed by:
Drain Tile $ �e
Plan Review Fee $ r
TITLE
o� CITY OF NORTHAMPTON
9« MASSACHUSETTS
OFFICE of the INSPECTOR of BUILDINGS
t c 3S2
Page �? Plot APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
' ZONING 4(/2/,
AT (LOCATION) `�`' DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING — A11 applicants complete Parts A — D -i
X
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
M
1 ❑ New building Residential Nonresidential
2 Addition0f residential, enter number 12 One family 18 Amusement, recreational
of ncu, housing units added, if any,
in Part D, 13) 13 ❑ Two or more family — Enter 19 ❑ Church, other religious
number of units— — — — --)P. 20 ❑J 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
p
Part D, 13) 16 17❑ Carport 24 L❑ Office, bank, professional
6 ❑� Moving (relocation) r L7 Other — Specify 25 L❑ Public utility
7 ❑ Foundation only r 0 26 School, library, other educational
B. OWNERSHIP /` `'/"r' L 27 L❑ 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
�f�j � processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement,,,,,,,,,,,,,,,, C?`'":4 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.).............
11. TOTAL COST OF IMPROVEMENT s3J o •wi
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 L� Masonry (wall bearing) 40 Public or private company 48. Number of stories................
square feet of floor area
Total sq ,
31 Wood frame 41 ❑, Private (septic tank, etc.) 49.
- all floors, based on exterior
32 Structural steel dimensions .....................
33 Reinforced concrete H. TYPE OF WATER SUPPLY
r S ect 42 R1 Public or private company 50. Total land area, sq. ft. ...........
34 �� Other — p fy P P Y
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL /
35 L.j Gas W 4 there be central air 52. Outdoors........................ �j4
36 [ Oil conditioning? ///
L. RESIDENTIAL BUILDINGS ONLY
37 I Electricity 44 I Yes 45
�' � r ,I No 53. Number of bedrooms..............
38 Coal
39 t_ Other — 1 / ' 46 Ye 47 T-.,,,� Full.........
S u�ci Will there be an evator
54. Number of
❑ No bathrooms
Partial......
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