35-037 (8) Vill ZONING •
DISTRICT
REAR YARD
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address —�Number, street, city, and State ZIP code Tel. No.
Owner or n
Lessee
t' Builder's
2. r * 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 confo T to all appli able la this jurisdiction.
Sign ure of appl' nt Address f Application date
00 NOT WRITE B E L 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 is
OTHER Is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number B Permit or Approval Chec Date Number B
Obtained y PP 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
VII. VALIDATION
Building /n/� FOR DEPARTMENT USE ONLY
Permit number
Building , Use Group
Permit issued 19
Building Fire Grading
Permit Fee $
Live Loading
Certificate of Occupancy $ Occupancy Load
$ App o�ved by:
Drain Tile
Plan Review Fee $
TITL
CITY OF NORTHAMPTON
�. .� MASSACHUSETTS
$ B OFFICE of the INSPECTOR of BUILDINGS
V 7
Page Plot 7 APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. 0
ZONING
I• AT (LOCATION) r DISTRICT ,
LOCATION (NO') SST EE )
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
iA
11. TYPE AND COST OF BUILDING — All applicants complete Parts A — D ;a
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For-Wrecking" most recent use rn
rn
--f
1 ❑ New building Residential Nonresidential
2 ❑ Addition(If residential, enter number 12 One family 18 ❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 Two or more family — Enter 19 Church, other religious
5C number of units— — — — -� 20 ❑� Industrial
3 Alteration (See 2 above)
14 ❑ Transient hotel, motel, 21 Parking garage
4/EN Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (11 multifamily residential, of units ——————— — -i 22 L� 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 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, 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 t
a. Electrical.......................
b. Plumbing .....................
1-it '/ )
r
c. Heating, air conditioning.......... Cie t
d. Other (elevator, etc.)
11. TOTAL COST OF IMPROVEMENT s/49,
III. SELECTED CHARACTERISTICS OF BU LDING — 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) 40 ❑ Public or private company 48. Number of stories..............
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
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 ❑ Gas Will there be central air 52. Outdoors........................
36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 Cf Electricity 44 Yes 45 " No
53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — Specify Will there be an elevator? m Full..........
�I � 54. Number of
46 ❑ Yes 47 _J No bathrooms
Partial......
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PINK
ADDRESS CANARY
WHITE FILE COP
APPLICANT . _...-
_ Y GREEN - FIELD COPY
DEPT. OF BUILDING INSPECTIONS BUILDING z°
212 Main Street Id
Northampton, M A 0 1 0 60 PERMIT
7
VALIDATION
V)
r`
DATE Jan. 26. 19 '� PE� RMIT NO.#y V)
APPLICANT 'i'r�i')'tl'1Pl�( i13'li(1C�k_ �r"'_ ADDRESS OI ±W' ii'� Rd.
�aS �t��:L7t: +� I�.,
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Ji "�j�(^� 'y1Sj�$ (_) STORY {�11 FA1711 V DWELLING UNITS
(TYPE OF IMP OVEME NT) NO. (PROPOSED U E)
ZONING
q ^
AT (LOCATION) Lgg )'IpS}L FarI�S Road DISTRICT ^I�
(NO.) (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 USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
permit For' alterations to sijjcj,' 7�tiTlily Ctwellin-, U'E.It`-_. to '.Ae �?{f7iration of
REMARKS: �'�` (5, ��pp�{ !1 /!,
buu i;i�; pej,mi V issue
AREA OR CIO PERMIT L
VOLUME ESTIMATED COST FEE s
(CUBIC/SQUARE FEET)
OWNER josIeph :aeryli;(
BUILDING pE,PT. �
., i a3S "ams Road
� r
ADDRESS BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK ASSESSORS COPY pjNT I1P