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FRONT YARD
SIDE YARD SIDE YARD
IX. SITE OR PLOT PLAN For Applicant Use
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NOTES and Data — (For department use) ,
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IV. IDENTIFICATION — To be completed by all applicants lk
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
1.
Owner or R6 re 6
Lessee
Bui Ider's
2, License No.
Contractor 0/0 eco,
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.
It re of plicant Address Application date
1-1 t .,- 4 — �—89
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans By Plans B Notes
9 Fee. Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL Is
OTHER Is
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Permit or Approval Check Obtained Number By Permit or Approval Check Obttaitned 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 �
Building Use Group
Permit issued at� 19 U'/
Building `pp Fire Grading
Permit Fee $ `'� D'
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $ Z
z'
TITL
CITY OF NORTHAMPTON
�+ .� • " MASSACHUSETTS
$ OFFICE of the INSPECTOR of BUILDINGS
�t Page IC Plot :26 APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
I• AT (LOCATION) C-lr �1 eSf"?� �;L V ZONING Q"
DISTRICT
LOCATION N°•I (STREET'
OF BETWEEN AND
BUILDING CROSS STREET) CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
il. TYPE AND COST OF BUILDING — All applicants complete Parts A — D -4
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
m
1 ❑ New building Residential Nonresidential
2 Addition(If residential, enter number 12 One family 18❑ Amusement, recreational
of new housing units added, if any, 13 ❑ Two or more family — Enter 19 L❑ Church, other religious
in Part D, 13) i t s— — — — --)o-3 ❑ Alteration (See 2 above) number of un 20 ❑ Industrial
14 ❑ Transient hotel, motel, 21 Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (11 multi family residential, of units ——————- — 22 �_� Service station, repair garage
enter number of units in building in 1.5 Garage 23 Hospital, institutional
Part D, ]3) ❑
16 Carport 24 Office, bank, professional
6 ❑ Moving (relocation)
17 Other — Speci/y 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,,,,,,,,,,,,,,,,
y 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....................... 000
b. Plumbing .....................
c. Heating, air conditioning..........
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT is 0
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❑ Masonry (wall bearing) 40 D 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 Electricity 44 Yes 45 No
53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — Specify Will there be an elevotor7 Full..........
46 r 54. Number of
l_ ] Yes 47 ::] No bathrooms
Partial........
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